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3 F� 12l� <br /> Please print or type.(Form designed for use on elite(12-pitch)typewriter.) Form Approved.OMB No.2060-0039 <br /> UNIFORM HAZARDOUS CAL 0 0 0 0 9 5 9 9 6 1 (800)424-9340 015481727 <br /> 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> JJ K <br /> WASTE MANIFEST <br /> 5.Generators Name and Mailing Address Generator's She Address(if different than mailing address) <br /> CCity of Manteca <br /> City of Manteca <br /> 1001 West Center Street,Manteca,CA 95337 1077 Milo Candini Drive,Manteca,CA 95337 <br /> Generator's Phone 249 456-8415 Attn: 2M Showerrnan U.S.EPA ID Number <br /> 6.Transporter 1 Company Name •) ( / � r r <br /> f U.S.EPA ID Number <br /> 7.Transporter 2 Company Name <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> Buttonwillow Landfill <br /> 2500 West Lokern Road,Buttonwillow,CA 93206 CAD 9 8 0 6 7 5 2 7 6 <br /> Facilitys Phone.(661)762-6200 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1 611 <br /> ceo <br /> NON-RCRA Hazardous Waste, Solids,(Lead) 0 0 1 D T 18 y <br /> LU 2. <br /> z <br /> 3 t <br /> I <br /> 4. <br /> 14.Si Handling Instructions and Additional Information <br /> Soil: 95-104% Clean Harbors Profile Number: C H 13 1 2 3 0 7 B <br /> Vegetation 0-5% Wear apEopnate Personal Protective Egaipment as neces <br /> 15. GENERATOR'SlOFFEROR'SCERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplacarded,and are in all respects in proper condition for transport according to applicabie international and national governmental regulations.If export shipment and k am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowiedgment of Consent. <br /> 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 quantity generator)is true. <br /> Month Day Year <br /> Generator'slOfferor's PrintedfTyped Name Signature ,!� <br /> (on behalf of the City of Maiteca.) <br /> -j 16.International Shipments <br /> ❑Import to U.S. ❑Expo t from U.S. Port trylexit: <br /> Z Transporter signature(for exports only); Date leaving U.S.: <br /> Q' 17.Transporter Acknowledgment of Receipt of Materials <br /> u! Month Day Year <br /> Transporter 1 PrintedfTyped Name Signature <br /> a / yr <br /> Z Transporler 2 PrinledlT d Name Signature Month Day Year <br /> a <br /> 18.Discrepancy <br /> 18a,Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br />`K <br /> F 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br />?K< J <br /> Facility's Phone; <br /> Month Day Year <br /> LU <br /> 18c.Signature of Alternate Facility(or Generator) <br /> a <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> O 1 �} 12. 3. 4. <br /> 20.Designated F Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 180 <br /> 9 month �Da Y <br /> r; PrintedfTyped Name Signature C/J~ <br /> ot f<1 <br /> Z <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED A ILITY T D STINATION STATE (IF REQUIRED) <br />=;r <br />