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Please print or type.(Form designed for use on elite(12-pitch)typewriter.) <br /> UNIFORM HAZARDOUS ID Number Form Approved.OMB No.2050-0(139 <br /> R -uou u" <br /> WASTE MANIFEST C AT 0 0 0 0 9 5 9 9 1, 7�19-cy�Repws.Ph. Approved. <br /> -"'-"u�' <br /> E cy t Tr.,k-1�­N­,,m­b.r---- <br /> 7�!(NO)424-9-300 1 um or <br /> 5.Generator's Name,and Maifng ri� 1 016542701 JJK <br /> Generators <br /> aws S". <br /> I I Address ff Of; <br /> City of Manteca ener W <br /> -Y I address; <br /> 100 1 West Center Street Manteca, City Of Manteca <br /> 091 4�� CA 95337 1077 Milo canchni Drive,Manteca,CA 95337 <br /> W,--- 2 <br /> Generators phone:(20-9)456-8415 Attn:Greg Showelman <br /> 6. WSPIM!'1 CompanyNarne <br /> Y-r"— <br /> CrAILI Number <br /> ..Transporter 2 Company Nam, td <br /> U Number <br /> 8.Designated rucinq Name and Site Address <br /> Buffonvifillow Landfill U.S.UA It)NUMMr <br /> 2500 West Lokern Road,Buttonwillow,CA 93206 <br /> Faciiq's Phone:(661)762 -6200 <br /> C A D 9 8 0 6 7 5 2 7 6 <br /> ga. 9b.U.S.DOT Description(hclud;'n 9 Proper Shipping Name,Hazard Class,ID Number, <br /> HM and Packing Group(itany,) 10,Containers <br /> 11.Total 12,Unit <br /> No, Ty)e Quantity wtjvol. 13,Waste Codes <br /> ix <br /> 6 1 1 <br /> 62NON-RCRA Hazardous Waste,Solids,(Lead) 001 DT' 18 Y <br /> 2, <br /> 4 <br /> I'L Special Handling Instructions and Additional Information <br /> Soil: 95-100% <br /> Clean Harbors Profile Number:C H 13 12 3 0 7 B <br /> -Vegetation:0-5% Wear mroprialte Personal Protective EcMiDment as necesmry <br /> 15 GENERATOR'ISICIFFEROR'S CERTIFICATION; I hereby declare that the contents of this consignment are Illy and accurately described al4ve by the Proper shipping name,arcs are classified,packaged, <br /> marked and iHbei0d/Placaroed,and are in al respects in proper condition for transport according to appi1cable Internationat and national governmental regulations.If expert shipment and t am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment 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)(91 am a small quantity generator)is true. <br /> �Gcnemlar`sJOfferoes PrfrtedfTy ed Name Signature <br /> +1 Month Day Year <br /> (on behalf of the CitY of Maraca) <br /> 7D17b.miernaitow Si <br /> n�pments El Import to U.S' <br /> Trinsporter signature(for exports onivi: Export from U.S. Port of entrylexit: <br /> Date leaving U.S.: <br /> Uj 17.Transporter AcknoWedgment of Receipt of Materials <br /> bir'r-a"sporterl intediTyGed[Name <br /> Month Day Year <br /> Z Irai Name C7 <br /> < Signature <br /> Month Day Year <br /> TL 1screpancy <br /> 18a Discrepa <br /> ocy Indication Space <br /> Quantity Type 17,Residue EJ Partial Rejection ❑Full Rejection <br /> Ntemate Facility(or Generator) cc Number: U.S.EPA ID <br /> Number <br /> FaCiRy's Phone: <br /> ;1on:b:eha1:f of�Ow City�()fm 1,nlure <br /> �rlteca) <br /> LL1 <br /> !7C Month Day Year <br /> Z <br /> Waste Report Management Method Codes(i.e.,codes for hazardous 1—f.1—f—f At sal.and recycling systems) <br /> LJA T- <br /> 2, <br /> 3. <br /> D signaled Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> nature <br /> EPA 870G 22 tKeV. Previous editions are obsolete. <br /> F�Ak f~l L I TY IDI <br /> ATE(IF REQLIIREDS� <br />