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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 015481718 J J K 5.Generators 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 Candini Drive,Manteca,CA 95337 GeneratarsPhone:(209)456-8415 Attn:Greg Showenman 6.Transporter 1 Company Name U.S.EPA 'IID�Number Q S. 6 05 7.Transporter 2 Company Name U. PAIDNumber 8.Designated Facility Name and Site Address U.S.EPA ID Number Butlonwillow Landfill 2500 West Lokern Road,Buttonwillow,CA 93206 Facilitys Phone:(661)762-6200 CAD 9 8 0 6 7 5 2 7 6 9a, 911.U.S.DOT Description(including Proper Shipping Name.Hai Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Patting Group(if any)) Na. Type Quantity Wt.Nol. K t. 611 0 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 Sal: 95-100% Clean Harbors Profile Number:C H 13 1 2 3 0 7 B Vegetation 0-5% Wear appropriate Personal Protective Equipment as necessary r 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 internatonal and national governmental regulations.If export shipment and I am the Primary Exporter,I cerofy 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)(if I am a small quant nerator)is true. Generetory0fferors Prin /Typed tedName SigneWre Monty Day Year (lm behalf of the City of Manteca) - -S I 8 II ...� 16.International Shipments p- ❑Import to US. Export from U.S. Port of ntrylexit: = Transporter Signature(for exports only): Date le 'rg U.S.: K 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 PrintedRyped Name SignaWre Month Day Year 0V QTransporter 2 Pd yped Name Signature Monty Day Year C r ♦ 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity El Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number I8b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facilitys Phone: W 1So.Signature of Alternate Facility(or Generator) Month Day Year 6 2 h19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1, 2. 3. 4. 1 ' �y 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item i8a PrintedRyped Name Signature Month Day Year r _ 103111.1 EPA Form 8700-22(Rev,3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)