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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 015481726 JJK 5.Ge erator s me and Mailing Address Generators Site Address(if different than mailing address) �><ty o �riartteca City of Manteca ]OOl West Center Street,Manteca,CA 95337 1077 Milo Candl Drive,Manteca,CA 95337 Generators Phone:(209)456-8415 Attn: Greg Showerman 6.Transporter 1 f�ompa Name ji U.S.EPA ID Number 7.Transponer 2 COm an Name c 0 �bu U.S.EPA ID Number 8.Designated Facility Name and Site Address Buttormillow Landfill U.S.EPA ID Number 2500 West Lokem Road,Buttonwiilow,CA 93206 Facil'iiy's Phone:(661)762 -6200 CAD980675276 93, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers HM and Packing Group(if any}) No. Type 11 nary 7nJ 12, 13.Waste Codes 1, O 611 NON-RCRA Hazardous Waste, Solids,(Lead) _ � CL 3 a01 DT 18 Y W 3. 71 4, I I I 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 EgWpment as necessary 15. GENERATOR'SfOFFEROR'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 labelediplacarded,and are in all respects in proper condition for transport aocmrding to applicable international and national governmental regufations.If export shipment and I 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 quanti enerator)is true. GeneratorslOfferoes Printed/Typed Name Signature Month Day Year (QI111P.�181f of the City O;FMtII1tECa� 16.International Shipments z5 4ES" ❑lmport to U.S. ❑Export from U,S. Po ntrylexit: Z Transportersignature(forexportsonly): Date leaving U.S.: w 17.Transporter Acknowledgment of Receipt of Materials Trans PrintecIff ed N e Signature O Month Day Year EL Transporter 2 Printedlfyped Name Signature jvMonth Day Year Ce 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Par4 Rejection ❑Full Rejection 18b.Alternate Facility(or Generator) Manifest Reference Number: U.S.EPA ID Number _J Facility's Phone: w 18c.Signature ol'Alternate Facility(or Generator) Month Day Year a z W19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1 Z 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/Typed Name `� Signature Month Day Y ar S O I A-�)' /--� D' EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FAC! ITY TO Q STI ATION STATE (!F REQUIRED)