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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,Generator ID Number 2.Page1 of7EMergeroy Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 0 9 5 9 9 6 1 0)4249300 015481704 JJ K 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) City of Manteca City of Manteca 1001 West Cerrter Street,Manteca,CA 95337 1077 Milo Candini Drive,Manteca.,CA 95337 Generators Phone:(209)456-8415 Atka: Greg Showerman 6.Transporter 1 Company Name nn e U.S.EPA ID Number JCS � G C'�12oao � Za. 7.Transporter 2 Company Name U.S.EPA ID Number S.Designated Facility Name and Site Address U.S.EPA ID Number Buttonwillow Landfill 2500 West Lokern Road,Buttonwillow,CA 93206 Facility's Phone:(661)762-6200 CAD980675276 ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)} No. Type Quantity Wt.Nvl, 13.Waste Codes 1. TT Ip NON-RCRA Hazardous Waste Solids (Lead) W 5 ,(L ) D T 1 8 Y Z 2. 0 a 3. i I 4. i tg 14,Special Handling Instructions and Additional information Soil: 95-100% Clean Harbors Profile Number: C H 13 12 3 0 7 B Vegetation: 0-5% Wear appropriate Personal Protective Equipment as necessary 15. GENERATOR'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 labeledlpiacarded,and are in all respects in proper condition for transport according to applicable international and national govemmental regulations.If export shipment and I am the Primary Exporter,I cerlify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identillied in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if l am a small qu 'ty generator)is true. Generator'sfOfferors Printed/Typed Name Month Day Year (on behalf of the City of Mani Signatur 2> t ri 18.IntemationalShipments F- LlImportto U.S. ❑Export from U.S. Port f entrylexit: — Transporter signature(for exports only): Date taving U.S.: LM 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name ^ Signature Month Day Year as �'� Z Transporter 2 Printed/Typed Name Signature CK 9 Month Day Year H 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 U - Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year a Z w19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1 3 3. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in[tem 18a Printed/Typed Name Si natu g Month Day Year r t� a c� r EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIG ATED FACILITY TO TINATION STATE (IF REQUIRED)