Laserfiche WebLink
-7— <br /> wllea!;e print or type.(Form designed for use on elite(12-pi-tch)typewriter.) Form Approved,OMB No.2050-0039 <br /> t.Gen tor ID Number 2.Pap I Paye Emergency Response Ph nfManifest Tracking Number <br /> UNIFORM HAZARDOUS <br /> WASTE MANIFEST ' I A L 0 0 0 0 9 5 9 9 6 (800)424-9300 T 016542702 JJK <br /> T Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> City of Manteca City of Manteca <br /> 1001 West Center Street,Manteca,CA 95337 1077 Milo Candini Drive,Manteca,CA 95337 <br /> Gere,ator'sPlione:(209)456-8415 Attrt:Greg Showertnan U.S,EPA ID Number <br /> 6.Transporter 1 Company Name <br /> 7.Transporter 2 Company Name r1a EPA ID Number <br /> 8 Designated Facility Name and Site Address U.S.EPA ID Number <br /> Buttonwillow Landfill <br /> 2500 West Lokem Road,Buttonwillow,CA 93206 <br /> Facility's Phoria:(661)762-6200 CA 990675276 <br /> ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.U61 13,Waste Codes <br /> HM and Pecking Group(if any)) No. Tipo Quantity ImiVd. <br /> 1. 611 <br /> NON-RCRA Hazardous Waste,Solids,(Lead) 001 DT 18 Y <br /> 2. <br /> 4. <br /> 14,Special Handling Instructions and Additional Information <br /> Soil: 95-100% Clean Harbors Profile Number:C H 131 2 3 0 7 B <br /> Vegetation:0-5% Wear ate Personal Protective Equipm <br /> ent as necessary <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fAy and accurately described above by the proper shipping name,and are class",packaged, <br /> ii marked and labeled/placarded,and are In all respects in proper condition for transport according to applicable international and national covernmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generatorl,or(b)(if I am a small quantity generator)is true. <br /> CeneratoesiOfferoes PrintediTyped Name Signature Month Day Year <br /> :j;��(On behalf of the City of Manteca) I All— <br /> rj 16.International Shipments <br /> 0 Import to U.S. ❑Export from U.S. Port Antry/ext! <br /> Transporter signature(for exports only): Date leaving U.3.: <br /> ii L= 17,TrarsporterAcknowledgment of Receipt of MaterialsU Transporter 1 Pri;tecf7yped Name Signature Month Day Year <br /> re- <br /> Transporter 2 Print d,'TypedNam Signature Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space Quantity ❑Type ❑Residue ❑Partial Rejection ❑Fuh Reiacticn <br /> Manifest Reference Nurr ber: <br /> 18b.Alternate Facility(or Generator) U.S,EPA ID Number <br /> Facility's Phone: in Day Year <br /> 18c.Signature of Alternate Facility(or Generator) <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> 1' 2. 3. <br /> W3 <br /> 20.Designated Facility Owner or Operator:Cerfitication of receipt of hazardous materials covered by the manifest except as noted in item 18e,LMonth Day <br /> Y' <br /> P t d'T ed.Name Signature 1671Z l 'in e�. <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. G t4 0 FAC,i I'Y <br /> (w RE:Qti1RE D) <br /> �N <br />