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Please punt ar type.(Form designed for use on eliteitch 12- t <br /> ( P )typewriter) <br /> UNIFORM HAZARDOUS f Generator Ip Number <br /> WASTE MANIFEST CAL 0 0 0 0 9 5 9 9 6 2.Page 1 of 3.Emergency Response Phone Form Approved,011 N .2 a-0a <br /> a. 39 <br /> M <br /> ani <br /> (est <br /> 5,Generator's Name and Mailing Address I (800)424-9300 T5acking Humber <br /> City of Manteca Generator's Sito Address(if different than mailingO 1 s} 4 1705 <br /> J <br /> 1001 West Center Street,Manteca,CA 95337 City of Manteca <br /> Generators Phone:{209)456-8415 Attn.-Greg Showerifnan1077 Milo Candini Drive,Manteca,CA 95337 <br /> 6,Transporter 1 Company Name <br /> 7,Transporter 2 Company Name © e— U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> ButtoTniii lOw Landfill <br /> 2500 West Lokern Roe U.S.EPA ID Number <br /> Road,Buttonwillow,CA 93206 <br /> Facility's Phone:(661) 762-6200 <br /> ga. U.S.OCTDescription <br /> HM and <br /> {including Proper Shipping Name,Hazard Class,ID Number, CAD 9 8 0 6 7 5 2 7 6 <br /> d Packing Group(if any)) 10.Containers � <br /> 1, 11.Total 12.Unit <br /> O <br /> No. Type Quantity Wt.NoI, 13.Waste Codes <br /> NON-RCRA Hazardous Waste, Solids,(Lead) 6 1 1 <br /> LU 1, - ._ . <br /> g <br /> r � <br /> i <br /> 4. n _,. _..._. __. , <br /> i <br /> { <br /> g I <br /> 14.Special Handling instructions and Additienal Information - <br /> Soil: 95-100% CIean Har J � <br /> bons Profile Number: C H 13 12 3 0 7 S <br /> i <br /> Vegetation: 0-5"/o Wear appropriate Personal Protective E <br /> 15. GE ked and R'SIOFFlacardI:ied,CERTIFICA7i0N: (hereby declare that the contents of this consignment are ful�ly�and�acecur:ate y d necessary hed it by p1B p�por Shipp ng name,arcf are classified—Packaged, <br /> marked and labeled/placard at th cont and are in all respects in proper condition for f the oil according to applicable international and national governmental regulations.If export shipment and I am the Prima <br /> Exporter,i certify that the contents of this consignment conform to the terms of the attached banal of Consent. p aged, ' <br /> I certify that the waste minimization statement identified in 40 CFR 262,27(a)(if I am a largo quantitygenerator)or(b)(if i am a small quantity ry <br /> GeneratorslGfferors PrintedlTyped Name <br /> q ty g rotor)is true. <br /> (°n behalf of the City of ManWca) Signature <br /> -J 16.International Shipments Manih Day Y r <br /> Z Transporter signature(for exports onl❑Import to U.S. 'IS 1 <br /> y). ❑Export from U.S. Port of en /exit: <br /> 17.Transporter Acknowledgment of Receipt of Materials Date leavin U.S.: <br /> Transporter 1 Print <br /> ed Typed Name <br /> dSignature <br /> 1[ Month Day ye <br /> aZ Transporter 2 PrfntedlTyped Name E <br /> Signat <br /> Month Day Yer li <br /> 18.Discrepancy <br /> 18,1.Discrepancy Indication Space <br /> ❑ Quantity ❑Type <br /> ❑Residue ❑Partial Rejection <br /> ❑Full Rejection <br /> 18b,Alternate Facility(or Generator} Manifest Reference Number: <br /> J U.S.EPA ID Number <br /> Facility's Phone: <br /> 18c.Signature of Alternate 1 acility[of Generator) <br /> q= Month Day Yea <br /> I <br /> Hall ft(6 R80 Management Mekhad Codes(I.e,,00des for hazardous waste treatment,disposal,and recycling systems) <br /> 3. 4. <br /> ardous materials covered by the manifest except as noted in Item 18a <br /> 4 er or Operator Certdication of receipt of as Month Day yes- <br /> 20.Designate F Pe Signature <br /> Printedil e x <br /> edit su�obsll-te.=PAFo 8700-22(Rev.3-05) Previous DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)� <br />