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Please print or type.(Form designed for use on elite(12-1 typewriter) Fon 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 015481717 J J K 5.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 Candint.Drive,Manteca,CA 95337 Genemtors Phone:(209)456-8415 Attn: Greg Showerman 6.Transporter 1 Company Name U.S.EPA ID Number 2107-2 CS. 7.Transporter 2 o any 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 Facith a Phone:( 1)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 13.Waste Codes HM and Packing Group(it any)) No. Type Quantity Wt Not. 611 9 NON-RCRA Hazardous Waste, Solids,(Lead) 0 0 1 D T 18 Y z 2. W 3, 4. 14.Special Handling Instructions and Additional Information Sod: 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 declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicable intemationaland national governmental regulations.If export shipment and 1 am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment 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)(if I am a small qu 'ty generator)is me. GeneratoeslOfferors Printed/Typed Name Signature Month Day Year (onbehalf of the City of Manteca) "VV _k.4 4_4i 3 8 l 16.International Shipments r E]Import to U.S. Export from U.S. Porto nbylexit: 2 Transporter signature(for exports only): Date l ving U.S: W 17 TmnsporterAcknowtedgment of Receipt of Materials Trans0 :1 Prtnted/Typed Name Signa Monty Day Year y ill"1 r ez / Transporter 2 Printe Name Signature Monty Day Year 18.Discrepancy 18a.Discrepancy Indication Spam ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number zi U W Facility's Phone: w 18c.Signature of Alternate Facility(or Generator) Monty Day Year Q Z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) O 1' I 2' 3. 4. 20.Designated Facility Owner or Operator:Certfimtion of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name I ' I L� 0"-Z 3 A, Signature Month 6a� Year EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. J Y` DESIGNATED FACIL Y TO D STI ATION STATE (IF REQUIRED)