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T5. 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 1 015481716 JJ K S.Generator's 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 Candeni Drive,Manteca,CA 95337 Generators Phone(209)456-8415 Attn: Greg Showetman 6.Transporter 1 Company Name U.S.EPA ID Number .if, L . %te-PIn";t 3q a? 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Buttonwillow Landfill 2500 West Lokern Road,Buttonwillow,CA 93206 Facilitys Phone:(661)762-6200 CAD980675276 ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class.ID Number, 10.Containers 11.Total 12.Un8 13,Waste Codes HM and Packing Group(#any)) No. Type Quantity WtNol. 611 K NON-RCRA Hanrdots Waste,Solids,(Lead) 0 0 1 D T 1 8 Y z 2 W V, 3. 4. I 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 Egldpment 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 Iabeledlplacarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.H export shipment and I am the Primary Exporter,I cer*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)(NI am a small quan' enerator)is true. GenerztorsrOffli Pnntedrryped Name Signature Month Del' Year (on behalf of the City of Manteca) � � 1 16.International ShipmentsEl F ❑Import to U.S. Export from U.S. Port of trylex#: Transpodersignature(forexports only)', Date i And U.S: w 17.Transporter Acknowledgment of Receipt of Materials may. Transporter 1 Pnntetle, 7T ped Name Signature Month Day Year � /, dCe+c # /7010 3 /7 MMonth Da Year QTransporter 2 Ryped Name Signatu V K F 1 18.Discrepancy I 18a.Discrepancy Indication Sparc ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U rai FacilitYs Phone: w 18c.Signature of ABemate Facility(or Generator) Month Day Year Q 2 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 11 2 2 3 4. 20.Designated Facility Owner or Operator CeNfiwtion of receipt of hazardous materials covered by the manifest except as noted in Item 18a 111 Printed rype0 Name yA ^ I O�� Signa u e Mon h Day Vear H vo EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILIT TO DESTINATION STATE (IF REQUIRED)