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ii <br /> Please print or type.(Form designed for use ort elite(12-pitch}typewriter.) <br /> 1.Generator ID Number Form Approved.OM 2050-0039 <br /> UNIFORM HAZARDOUS 2.Page 1 of 3.Emergency Response Phone 4,Manifest Tracking Number <br /> WASTE MANIFEST CAL 0 0 0 0 9 5 9 9 6 1 (800)424-9300 015 4 817 0 8I K <br /> 5.G r tor's and Mailing Address Generator's Site Address(if different than mailing address) <br /> 111 Weer Street,Mantes C City Of Manteca <br /> (209)456-8415 Attn: Greg Showey <br /> Manteca, A overman 1077 Mrlo Candini Drive,Manteca,CA 95337: <br /> Generator's Phone: <br /> 6.Transporter 1 Company Name <br /> U.S.EPAP Number <br /> 7.Transporter om <br /> pany Name <br /> c_d V <br /> U.S.EPA ID Number <br /> 8.ta f4ddress <br /> R <br /> 2500 West Lokern U.S.EPA ID Number <br /> 04 Buttonwillow,CA 93206 <br /> (6d1)762-6200 CAD980675276 <br /> Facility's Phone: i <br /> ga. 9b.U.S.DOT Descripb'on(including Proper Shfpping Name,Hazard Class,ID Number, 10.Containers <br /> HM and Packing Group(if any)) 11.TotalT12. 13.Waste de1. No. Type Quantity <br /> NON-RCRA Hazardous Waste, Solids,(Lead) 0 0 1 D T 18 Y <br /> Z <br /> 2' <br /> LU <br /> r, t <br /> 3, <br /> r <br /> I <br /> 4. <br /> 14. ec' I Hapolingjr�touro°ons and Addition orm n <br /> yyJJ 11VV((t)''770 arbor;Profile Number: C H 13 12 3 0 7 E <br /> Vegetation 0-5% Wear appropriate Personal Protective Equipment as necessary <br /> I <br /> [G. <br /> GENERA:nbel <br /> QFFEROR'SCERTIFICATION: Thereby declare that the contents of this consignment are Tully and accurately described above by the proper shipping name,and are classified,pa ag , <br /> marked aed/placarded,and are in all respects in proper condition for transport according to applicable intemational and national governmental regulations.If axport shipment and I am the PA ary <br /> Exporter, that the contents ofthis consignment conform to the terms of the attached EPAAcknowledgment of Consent.I certify thaste minimization statement identified in 40 Cl 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> eratoris/Offeror's PrintedlTyped Name (on behalf of the City of MawAca) signature <br /> Month Da Year <br /> � 16.International Shipments { <br /> H ❑Impart to U.S. ❑Export from U.S. Port of nbylexit: <br /> Transportersignature(forexportsonl <br /> y) Date Ie ing U.S.: <br /> Li 17,Transporter Acknowledgment of Receipt of Materials <br /> jj Transpo er1 Pnnied/Typed me <br /> 0 Signatu <br /> CL Month Day Year <br /> Qra sporter 2 Prin yp a e <br /> Signature onto a <br /> Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑Residue <br /> ❑Partial Rejection ❑Full Rej clfo <br /> 18b.Alternate Facility(or Generator) Manifest Reference Number: <br /> U.S.EPA ID Number <br /> U I <br /> L Facility's Phone: <br /> LU 18c.Signature of Alternate Facility(or Generator) <br /> Q Month Day Year <br /> Z <br /> w19.Hazardous Waste Report Management Method Codes(ie,codes for hazardous waste treatment,disposal,and recycling systems) <br /> C3 1. � � � � 2. 3 <br /> 4. I <br /> i <br /> 20.Designated Facility Owner or Operator;Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printed ed Namg <br /> YSignator Month Da ear <br /> ! Q '. y <br /> EPA Form 8700-22(Rev.3-05) Previous editions are oDsoletefrf <br /> DESIGNATED FACILITY TO D STINATION STATE (IF REQUIRED) <br /> l <br /> i <br />