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Please print or type.(Form designed for use on elite(12-pdch)typewriter.) Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1,Generator ID Number 71, .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 015481719 J J K 5.Generator's Name and Mailing Address Generators Site Address(ddiferent than mailing address) City of Manteca City of Manteca 1001 West Center Street,Manteca,CA 95337 1077 Milo Candirli Drive,Manteca,CA 95337 Generators Phone:(209)456-8415 Attn: Greg Showeanan 6.Tanspo> Company Name I U.S.EPA ID Number ` 7.Transporter 2 Company Name U.S.EPA ID Number S.Designated Facility Name and Site Address U.S.EPA ID Number Buttonwillow Landfill 2500 West Lokern Road,Buttonwillow,CA 93206 Fadlitye Phone:(661) 762-6200 CAD 9 8 0 6 7 5 2 7 6 ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HM and Packing Group(if any)) 13.Waste Codes No. Type OuantRy WI.NoI. 1 0 611 Ni Hazardous Waste, Solids,(Lead) 00 1 D T 18 Y z 2 w O 3. 4. 14,Special Handling instructions and Additional Information Soil: 95-100% Clean Harbors Profile Number: C H 13 12 3 0 7 B Vegetation 0-5% Wear appropriate Personal Protective Equipment as necessary 15. GENERATOR'S/OFFEROR'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 intematonal 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 EPAAcknowledgmenl of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(d I am a large quantity generator)or(b)(if I am a small quan' neator)is due. Geneatoes/ORemes Pdntedrryped Name Signature Month Day Year (on behalf of the City ofIV. taCaca) g I J 16.International Shipments ❑ _ le Import to U.S. ❑ExpoR from U.S. Port ingtrylexit Transporter signature(for exports only): Date leting U.S.: w 17.TanspoRerAcknawletlgment of Receipt of Materials Transporter 1 Phi Name Signature onN Day Year 13- Pic IIIO , / do i Transporter 2 Prin ped Name x G ` I � Signature Month Day Year F } 18.Discrepancy 18a.Discrepancy Indication Space ❑ Ouantiry, ❑Type Ll Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number 18b.Attemate Faality(or Generator) U.S.EPA ID Number J U LL Facility's Phone: w 18c.Signature of Alternate Fadlily(or Generator) Q Month Day Year z 19.Hazardous Waste Report Management Method Codes(i e,,codes for hazardous waste treatment,disposal,and r ing systems) 0 7, 1 1t 1 n Jz 4. 20.Designated F1acility Owner or Operator'.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a illl Printecirfyped Name Signature Month Day Year EPA Form 8700-22(Rev 3-05) Previous editions are obsolete. DESIGNATED FA IL TY DE TINATION STATE (IF REQUIRED)