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I I I I Please print or type.(Form designed for use on elite(12-�09 itch)typewrtter.) Fom�Approved.OMB No.; 5 -0039 1.Generator ID Numbe2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number '�'7 UNIFORM HA2ARDDUS C A 0 0 05 9 9 t5 1 (800}424-9300 O ,015481707 817 1 J WASTE MANIFEST 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) City of Manteca City of Manteca 1001 West Center Street,Manteca,CA 95337 1077 Milo Candini Drive,Manteca,CA 95337 GeneratorsPhone:(209)456-8415 Att '.Greg Slbowerman U.S.EPA ID Number 6.Transpprter'kCo pVName xiU.S.EPA ID Number7.Transpo r 2 C p U.S.EPA ID Number 8.Designated Facility Name and Site Address Buttonwillow Landfill 2500 West Lokem Road,ButtonwillOW,CA 93206 CAD 9 8 0 6 7 5 2 7 6 Facility's Phone:(661)762-6200 ga 9b.U.S.DOT Desorption(including Proper Shipping Name,Hazard Class,lD Number, 10.Containers 11.Total 12.Unit 13.Waste Cod HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 611 elf 0 001 DT 18 Y NON-RCRA Hazardous Waste, Solids,(Lead} Z 2. tm_� LU 3. 14.Special Handling Instructions and Additional Information Soil: 95-100% Clean Harbors Profile Number: C H 1 3 1 2 3 0 7 B Vegetation 0-S% Wear appropriate Personal Protective Egaipmerd as necessary 15. GENERATOR'SfOFFEROR'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, red, marked and iabeledlplacarded,and are in all respects in proper condi8onfor transport according to applicable International and national governmental regulations.If export shipment and I am the . y 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 quantity aerator)is true. Month Year Generators101ferors PrintedlTyped Name Signature y (oil behalf of the City of Maruti1-1 16.International ShipmentsImport to U.S. ❑Export from U.S. Port of a lexik Date is U.S.: Transporter signature(for exports only): aving W 17.Transporter Acknowledgment of Receipt of Materials CL Tran 1 Printedlr ped Name Signature Month y Year f / W Sign Month y Yea r QTranspo er 2 Printe erne IlK F 18.Discrepancy ' 18a.Discrepancy Indication Space Quarflty ElType ❑Residue ❑Partial Rejection ❑Ful ejection i Manifest Reference Number: U.S.EPA ID Number 18b.Aiternate Facility(or Generator) C.1 W Facilites Phone: Month Year w 18c.Signature ofAltemate Facility(or Generator) a Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) C 1, 2. 3. 4 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Month i 5a—y Year Printedrryped Name Signature EPA Form 8700-22(Rev.3-05) Previous editions are obsolet DESIGNATED FACILITY DESTINATION STATE (IF . QUIRED)