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Form Approved.OMB No.2050-N36
<br /> .d.Manifest Tra+ 9 Nwber
<br /> F:"'as.print or type,(FOM designed for use on 611te{12pitch} writer-) envy Response—PhOn.
<br /> P'_ .Gonefator ju Number 2.Page I Of 3.Emeng 016542704. JJK
<br /> iAZARDOUS I ss)
<br /> UNIFORM I i N (800)424-9300
<br /> WASTE MANIFEST I CAL 000095996 Generators She Address(if diffel ntrhatimaitrigWre
<br /> ,er�,enR P ons
<br /> q esp-;o
<br /> goo)424-9
<br /> if 'Oes Site d
<br /> !09 5)9 9`:6 ��Ga Generators, Address
<br /> Generator's Name and Malling Address City of Manteca
<br /> City of Manteca 1077 Milo Candiyd Drive,Manteca,CA 95337
<br /> 1,00�I:West West Street,Manteca,CA 95337
<br /> 't Us,EPA ID Number
<br /> ,n,,,,,,,p,,,,(209)j456-84l5 Altn-GTegShOwerman
<br /> 6,Transporter 1 GomPanY Name
<br /> I ISDAS.EPAID umber
<br /> 17,Transporter 2 Company Name EPA
<br /> Q Number
<br /> 8.Desiig��tedFacility Name and site Address
<br /> ButtormillOw Landfill 2500 West Lokern Road,Buttonwillow,CA 93206 CAD 980675276
<br /> Facilit,5 PbOrf(661)762-620010.Containers 11'"retal 12.U,n't 13.Waste Codes
<br /> 92 91b.U.S.DOT Dpsc-"iation(including proper Shipping Name,Hazard Clog-ID Number. No. Quantity WLP Ol.
<br /> HM
<br /> and Packing Grasp(if-Y))
<br /> 1.
<br /> >
<br /> NON-RCRA HazardousWaste,Solids,(Lead)
<br /> 401 1)T 1
<br /> 8 YC
<br /> 2.
<br /> L15
<br /> —4-
<br /> 4.
<br /> 14,Special Handling Instruptiors and Add;IWBI InfounZo-,
<br /> Soil: 95-100% Clean Harbors Profile Number:C H 1 3 12 3 0 7 B
<br /> name,arid are classified.pa c�kaged
<br /> ate Personal protective E_TypT Tit i rte,Snt as"S c es
<br /> Ve etation:0-5% 11� i:al, ]l bed above by the proper ship
<br /> W tion
<br /> culne of this cons119-11-1,are fu'jy and accurately des, d I am the Primary
<br /> 15 GENERATOFVS 1;g0—FV�SCER-nFlCAn0N:I hereby declare In roinal and nauctial governmental regulations.It export shilirren'an
<br /> all respects in proper condition for transport according to applicable inverna
<br /> marked x'Id jabejadfpjacarrded,and are in nt conform to the terms of the attached EPA Acimcwfodg—t Of Consent. antitY
<br /> "penta" certify that the contents of this consignment eraw)or(b)(d I am a—L quart generator)is true pay Year
<br /> nt identired in 40 CFR 26227(a)(if I am a large quantity gel
<br /> I certify that the waste minimization statement .11 1� I
<br /> Genefaloes,,Offerorls PrintedIryped Name t beha]f of the City
<br /> '19naure
<br /> Cf�Aq L-L-�' �don
<br /> 16.IntemalWall ShipmentsExport fn)'n U.S. Port of en ry/exif
<br /> import 4.0 U.S, ❑ Date leavi Ig U'S.�
<br /> Transporter signature(for exports only}:
<br /> W 17.Transoorterk edgment ot Receipt of Materials pay Year
<br /> LLJ S 5- 17
<br /> i2 Transporter I prin IN no -
<br /> ted'Ty '43r
<br /> R - V Ana A�O Signature Month Day Year
<br /> Trans er 2 Printe , Name
<br /> ix
<br /> 18.Discrepancy Ful Rejector On
<br /> Ty ❑Residue ❑Partial Refed
<br /> 16a.Discrepancy Indication SpaceD Quantity
<br /> Manifest Referens U.S.EPA W Mnluef
<br /> 18bAtemateFaci (or Generator)
<br /> Year
<br /> W18c,Signature OtMr-
<br /> emale auMY(or Generator)
<br /> 19.Haza nus Waste Report Management Method Codes k`i,e.,codes for hazardous waste treatment,disposal,and recycling systems'
<br /> LU I
<br /> 4.
<br /> C3
<br /> 20.Designated Facility Owner Or Operator:Certification of receipt of hazardous materials covered by the manifest except as ncled in Item 18a
<br /> Printed,rryped Name Signature Month Day Year
<br /> F r -ins,Avs-11*
<br /> EPA Form 8706-22(Rev.3-05} Previous editions are obsolete.
<br /> --�710'iNl 3:7 PEQuIREu
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