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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.Gep>;r4todD Nuyrber0 9 5 9 9 6 2.Page 1 of 3.Er08r�a0�424rise 9300ne d,Manifest Tracking Number WASTE MANIFEST ll::AA LL UU UU 0U 1 l 015481741 JJ K 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 Company Name U.S.EPA 10 Number v /J 7.Transporter 2 Company Name US.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number Buttonwillow Landfill 2500 West Lokem Road,Buttonwillow,CA 93206 Facility's Phone:(661)762-6200 CAD980675276 9a 9b,U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11,Total 12.Unit HM and Packing Group(if any)) No. Type Quantity WtNol. 13.Waste Codes 1. K Ni Hazardous Waste, Solids,(Lead) 0 0 1 D T 18 y z 2_ 3. I i 4. 14.Special Handling Instructors 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 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 classfied,packaged, marked and Iabeladlplacarded,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 Nat the contents of this consignment conform to the tens of the attached EPAAcknowtedgment of Consent. I certdy 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 emtor)is true. GmeratorsrOSemesPrintadrrypedName (on behalf of the City of Manteca) Signature Month Day Year J16.International Shipments H ❑Import to U.S. ❑Export from U.S. Pod of en lexib Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Pdntedffyped Name Signature Month Day Year 11 .4Q Transporter 2 Printed/Typed Name Signature M D Year X H } 18.Discrepancy 18a.Discrepancy Indicabon Space ❑ Quantity ❑Type El Residue El Partial Rejection El Full Rejection Manifest Reference Number: 18b.Ahemate Facility(or Generator) U.S.EPA ID Number J U LL Facility's Phone: w 18c Signature ofAltemate Fadlily(or Generator) Month Day Year 6 Z y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 1. 2. 3. 4. Iff 2, 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printedrryped Name Signature Month Day Year 3 EPA Form 8700-22-(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE (IF REQUIRED)