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Please print or type.(Form designed for use on elite(12-pitch))pewriter.) Form Approved.OMB 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 015481711 J J K 5.Generator's Name and Mailing Address Genemmes 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 Generators Phone: 209 456.8415 Attn: Greg Showerman 6 Transporter 1 Company Name '/! U.S.EPA ID Number S /4 N 9 V 7.Transputer 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Buttomvillow Landfill 2500 West Lokem Road,Buttortwillow,CA 93206 Faciliys Phone:(661)762-6200 CAD 9 8 0 6 7 5 2 7 6 9a 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class ID Number, 10 Containers 11,Total 12.Unit 13 Wawa Codes HM and Packing Group(ff any)) No Type Quantity WtIVoL 1. 611 K O NON-RCRA Hazardous Waste, Solids,(Lead) 00 1 D T 18 Y z 2. w r7 3 4. 14.Special Handling Instructions and Additional Information Soil: 95-1000/0 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 dedara 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 EPAAcknowledgment of Consent. I pertly that the waste minimization statement identified in 40 CFR 262.27(a)(it I am a large quantity generator)or(b)(if I am a small qua tor)is true. Generalor'sl0ffemes PrintediTyped Name Signature Monts Day Year (on behalf of the City of Mm[eca) 3 14S � 16.International Shipments i— ❑Import to U.S. Expos from U.S. Pat of /aril = Transporter signature(for exports only): Date lea'rg U.S.: Lou17.Transporter Acknowledgment of Receipt of Materials KMonth yea Trnsp1 Pnled Signaturs D O /7CIL Z Transporter 2 Pdntedrryped Name Sgnatura Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: F 1 Bo Atemate Facility(or Generator( U.S.EPA ID Number J U LL Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Month Day Year G Z N19.Hazardous Waste Report Management Method Codes fi.e,codes for hazardous waste treatment,disposal,and recycling systems) O � � 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 Pdntedfryped Name Q, 1Il/1�� 6 V- ^IlllD Z Signature -3 Day Year 'l 0 0 EPA Form 8700-22(Rev.3-05) Previous editonsare obsolete. DESIGNATED FA ILITYT STINATION STATE (IF REQUIRED)