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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.CMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 0 9 5 9 9 6 1 (800)424-9300 015481709 J J K 5.Generator's Name and Mailing Address Generetors Site Address(if different than mailing address) City of Manteca City of Manteca 1001 West Center Street,Manteca,CA 95337 1077 Milo Candor i Drive,Manteca,CA 95337 Generators Phone(209)456-8415 Attn: CklegShowerman 6.Transpoder 1 Comm Neme U.S.EPA ID Number In C,V 00 7.Transporter 2 Company his U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Budonwillow Landfill 2500 West Lokem Road,Buttom+illow,CA 93206 Fadlitys Phone:(661)762-6200 CAD 9 8 0 6 7 5 2 7 6 aa, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Padang Croup ferry)) No. Type 01WtNol. 13.Waste Codes a I' 611 O NON-RCRA Hazardous Waste,Solids,(Lead) 00 1 D T 18 Y z 2. W f7 3. 4. 14.Special Handling h sbucdons and Additional Information Soil: 95-100% Clean Harbors Profile Number: C H 13 12 3 0 7 B Vegetation 0-5% Wear appoprrate Personal Protective Equipirrient 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 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 261(if I am a large quantity generator)or(b)(if I am a small anjty generator)is We. 3eneratoesr08eroi PrintedlTyped Name Signatures Month Day Year (on behalf of the City ofManteca) /J\ CAAA-CAAJGC— a� g 1 J 16.International Shipments F ❑Import to U.S. ❑Export from U.S. f entry/exit = Transporter signature(for exports only): Dae leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Tmnsponer 1 PrintedrTyped Name Sign Month Day Year a N Z M—nipoRer2 Pnntedv iyw Name Signature Month !D71 y Year C F t18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection Dull Rejection Manifest Reference Number. 181b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Fadliry's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year 6 z H19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1. f 2. 3. 4. 1 20.Designated Facilityr emdr:Certification of receipt of haze materials covered by the manifest except as noted in Item 1 Be Fri typed Name / Signature EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED)