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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 C A L 0 0 0 0 9 5 9 9 6 1 (800)424-9300 015481721 JJK_ 5 Generator's 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 Attn: Greg Showerman 6.Transporter 1 Comp y Name U.S.EPA ID Number f e✓ �- 50P/iG S 6 7.Transporter 2 Corlipany 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 Facility's Phone:(661) 762 -6200 C A D 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 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 1 61 1 O NON-RCRA Hazardous Waste, Solids,(Lead) 0 0 1 D T 1 8 Y w z z. L c� 3 4. 14.Special Handling Instructions and Additional Information Soil: 95-100% Clean Harbors Profile Number: C H 1 3 1 2 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 international 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 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 quanti erator)is true. Generators/Offerors Printed/Typed Name Signature Month Day Year (on behalf of the City of Manteca) 8 .-i 16.International Shipments i— ❑Import to U.S. ❑Export from U.S. Port of ent /exit: Z Transporter signature(for exports only): Date Ieavin U.S.: W 17 Transporter Acknowledgment of Receipt of Materials OTran r Printed TyVdN meSignature ♦ Month Daly Year CL U) Z Transporter 2 Printed/Typed Name Sign a Month Day Year F- t- 18.Discrepancy 18a.Discrepancy Indication Space El Quantity F]Type ❑Residue ❑Partial Rejection El Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: Lo 18c.Signature of Alternate Facility(or Generator) Month Day Year tR Q Z O N 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LLJ 1. I � �7 2. 3. 4. 20.Designated`Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed(fyped NameF. Signature Month �Day /Yea l EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATEDfACILITtTll� DESTINATION STATE (IF REQUIRED)