FIELD DOCUMENTS - Laserfiche WebLink

Home Browse Search

Please print or type.(Form designed for use on elite(12-pitch)typewriter.) 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 015481713 J J K 5.Generators Name and Mailing Address Generator's 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 Atbr Greg Showeanan 6.Trans er;.8ompany Name U.S.EPA ID Number 6P,IJ 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Buttmtwillow Landfill 2500 West Lokern Road,Buttonwillow,CA 93206 Facility's Phore(661)762 -6200 CAD 9 8 0 6 7 5 2 7 6 ga 91h.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(ff any)) 13.Waste Cotler No. Type Quantity Wt.Nol. 1. 0 611 ~� NON-RCRA Hazardous Waste, Solids,(Lead) 0 0 1 D T 18 Y z 2. out 3. 4. T- 14.Special Handling Instructions and Additional Information Soil: 95-1000/a 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 declare that the contents of this consignment are fully and accurately described above by th proper shipping name,and are classified,packaged. marked and labeled/placeroed,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am to Primary Exporter,I certify that the contents of this consignment conform to the terms of he attached EPAAcknoWedgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(A I am a large quantity generator)or(b)IRI am a small quanb enemtor)is true. Generators/Offerors Printed/Typed Name Signature Mont Day Year alf (on behof the City of Manteca) / 3 �r J 16.International Shipments r- ❑Import to U.S. ❑Expod from U.S. Port of trylexit Transporter signature(for exports only)' Date lea ing U.S.. w 77.Transporter Acknowledgment of Receipt of Materials Transporter 1 PrintedrTyped Name ar7 Signature Month Day Year QI ranspoder 2 PnntWffyped Name Sin re g Mont Day YeAr F } 18.Discrepancy Ise.Discrepancy Indication Space ❑ Quantity ❑ Type ❑Residue ❑Partial Rejection ❑Full Rejection Mandesl Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA IDNumber J U LL Faaldy's Phone: w 18c.Signatumofmtemam Faolity(or Generator) Month Day Year 6 z CD 19.HazardnRepolment Method Codes f.e..codes for hazardous wastetreatment,disposal,antl recycling systems) 0 1. 3. 41 20.Designrator:Certification of receipt of hazardous materials covered by to manifest except as noted in Item Ise Pnnted?ySignaNreMon Da ear � 6 �2 0 � t7 EPA Form 8700-22(Rev.mti) Previous editions are obsolete. DESIGNATED FA LITYT D STINATION STATE (IF REQUIRED)