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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 Ma nifest Tracking� 8 1 Number 2 5 J J K WASTE MANIFEST C A L O 0 0 0 9 5 9 9 6 1 (800)424-9300 1 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 Candird Drive,Manteca,CA 95337 Generator's Phone:(209)456-8415 Attn: Greg Showerman U.S.FPA ID Number 8.Transporter 1 Company NameAW 1 —7t] U. A D umber (d 7.Transpo a mpany Name B.Designated Facility Name and Site Address U.S.EPA ID Number Buttonwillow Landfill 2500 West Lokern Road,Buttonwillow,CA 93206 CAD 9 8 0 6 7 5 2 7 6 Facility's phone:(661)762-6200 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 W1:1vol. 1. 611 t . _ —4- 0 _ NON-RCRA Hazardous Waste, Solids,(Lead) 0 0 1 DT 18 Y z 2. LLI 4- 3 � 4..,_...__� I i 4. j � s 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 PersmW 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 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 10 the terms of the attached EPA Acknowledgment of Consent. I certify that the waste m nimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small q tlty generator)is true. Generator'slOfferor's Printed/Typed Name Signature Month Day Year (on behalf of the City of Maruteca) t� l j 16.International Shipments H ❑Import 10 U.S. ❑Export from U.S. Port f entrylexit: Z Transporter signature(for exports only): Date aving U.S.: 17.Transporter Acknowledgment of Receipt of Materials Tporter 1 Prin dffyped N Signature Month D Year r2` O aTra sport "Pr�,ntdd7ypea Nam Signature onth ay ear f- 18.Discrepancy 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number 18b.Alternate Facility(or Generator) U.S.EPA 10 Number U Facility's Phone: 18c.Signature of Alternate Facility(or Generator) Month Day Year LUa z 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LU 2. =f 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as nded in Item 18a ss Month Da Year PrinledlTyped Name � � Signature EPA Farm 8700-22(Rev.3-05) Previous a 'scions are obsolete. DESIGNATED FACI TY DES !NATION STATE (IF FlEQt11R °.?) 6=: