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Please print or".(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.Mi n"test Tracking Number WASTE MANIFEST CAL 0 0 0 0 9 5 9 9 6 1 (800)424-9300 1 015481728 JJ K 5 G rators and Mailing Atltlress Generators Site Address(if different than mailing address) 1 Weser Street,Manteca,CA 95337 City of Manteca 1077 Milo Candini Drive,Manteca,CA 95337 (209)456-8415 Attn: Greg Showerman Generators Phone: 6.Transporter 1 Company Name U.S.EPA ID Number W. L° . G. •5 SNL #gf40 F2 62 7,Transporter 2 Company Na a U.S.EPA ID Number B.Designated Facility Name and Site Address U.S.EPA ID Number Buttomvillow Landfill 2500 West Lokern Road,Buttorrwillow,CA 93206 Facility's 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(it any)) 13.Waste Codes No. Type Quantity Wt.Nol. a 1 611 NON-RCRA Hazardous Waste,Solids,(Lead) 0 0 1 D T 18 Y w Z 2. W C7 3. 4. 14.Special Handling InsWctors and Additional Information Sal: 95-1000/0 Clean Harbors Profile Number: C H 13 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 far transport according to applicable intemationaland 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 EPAAclohowledgment 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 quantity generator)is true. Generators/Otenaa Pdnted7Typed Name Signature Month Day Year (on behalf of the City of Manteca)F -F> $ I 16.International Shipments ❑Import to U.S. ❑Expod from U.S. Pod o /exit: Transporter signature(for exports only): Date leafing U.S.: w 17.Transporter Acknowledgment of Receipt of Materials C Transporter 1 Printed yped Name y / O SgnaN Month Day Year Z Transport dnted/Typed Name �d Signatu Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑PaNal Rejection El Full Rejection Manifest Reference Number: 18b.Alternate Facility(a Generator) U.S.EPA ID Number J U LL Fauldys Phone: W 18c.Signature ofAnernme Faciury(or Generator) Monro Day Year Q Z H19.Hazardou Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) D iL � 2. 3. Dsignated Facil y Own o peratoECer tion of racept of h do materials covered by the mannest except as nded in em 18a t (fyped Name Signature Monty Day Year EPA Forth 8700-22 ev.3-05) Previous edNons amo solete. DESIGNATED FACILITY TO DESTINATION STATE (IF REOUI ED)