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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.GEf1eA1oVgP@ Jy-r0 9 5 9 9 6 2.Pale 1 of 3.E(8B5yy�§PQ9st9b°ne 4.Manifest Tracking Number WASTE MANIFEST `V 015481703 JJ K 5 Ge erator's a and Mailing Address G neratol t Address(if different than mailing address) 1ty oto anteca ty of anteca 1001 West Center Street,Manteca,CA 95337 1077 Milo Candini Drive,Manteca,CA 95337 (209)456-8415 Attn: Greg Showerman Generators Phone: 6.Transporter 1 Company Name U.S.EPA ID Number d�/ ✓/dG/c�^ f{ROOo s�/.S� 7.Transporter 2 Company Name U.S.EPA ID Number 8 t3IITCOnW1 0 Lz8hAddress U.S.EPA ID Number 2500 West Lokern Road,Buttonwillow,CA 93206 (661)762-6200 C A D 9 8 0 6 7 5 2 7 6 Facility's Phone: ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol 1. NON-RCRA Hazardous Waste, Solids,(Lead) 0 0 1 D T 1 8 Y z 2. w c� 3. 4. 14 Special Handling Instructions and Additional Information Soil: 95-100% Clean Harbors Profile Number: C H 13 1 2 3 0 7 B Vegetation: 0-5% Wear appropriate Personal Protective Equipment as necessary 15. GEN ERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small qwantity generator)is true. Generator's/Offeror's Printed Typed Name (on behalf of the City of Manteca) Month Day Year Signatur Zv Q. ' 16.International Shipments F— ❑Import to U.S. Export from U.S. Poof entry/exit: — Z Transporter signature(for exports only): Dat eaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials W Transporter 1 Printed/Typed Name Signature Month Day Year 9 a A /jN�nzcv Z Transporter 2 PrinteclTDOcl Name Signature Month Day Year Q t- 18.Discrepancy 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U i— Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year Q z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LLJ 1, 12, 3. 4. 20.Designated Facility 0 er Operator:Certification of receipt of hazard s materials covered by the manifest except as noted in Item 18a Printed/Typed Name � � Signature Moi D Year EPA Form 8700-2 (Rev.3-05) Previous editions are o solete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)