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P ease print or type.(Form designed for use on elite(12-pitch)typewriter) Form Approved.OMB No.2050-0039 <br /> 2.Page 1 of 3.Emergency Response P e 4.Manifest Tracking Number <br /> UNIFORM HAZARDOUS (800)424,9 016542705 JJK <br /> WASTE MANIFEST C A L 0 0 0 0 9 5 9 9 6 luis V Generator 10 Number <br /> Generator's Name and Mailing Address Generators Site Address(if citterimt man mailing address) <br /> City of Manteca <br /> City f Manteca <br /> 10010' est Center Street,Manteca,CA 95337 1077 Milo Candird Drive,Manteca,CA 95337 <br /> .!generators Phon�2 4 Showennan U S.EPA ID'Nurnber <br /> 6,Transporter ; party Name, :4�i W <br /> a . A <br /> Transcionei 2 Company Name EPA 11)Number <br /> 3.Designated Facility Name and Site Address U.S.EPA ID Number <br /> Buttonwillow Landfill <br /> 2 500 West Lokem Road,Buttonwillow,CA 93206 CAD 980675276 <br /> :acifit Is Phone,(661)762-6200 <br /> ga. 9b,U.S.DOT Description(including Proper Shipping Name,HazardClass,ID Number, 10.containers 11.Total 12.Unit 13.Waste Codes <br /> l Hyl and Packing Group(if any)) No. Ty,)e Quantity Wt Not. <br /> 1. 611 <br /> NON-RCRA Hazardous Waste,Solids,(Lead) 001 D 18 Y <br /> UJ <br /> 2. <br /> LU <br /> CD <br /> 3. <br /> 4. <br /> -fAli IST/- <br /> 74 Special Handling Instructions and Additional Information <br /> i - Soil: 95-100% Clean Harbors Profile Number:C H 13 1 2 3 0 7 B <br /> I Vegetation:0-51/- <br /> ;15. GENERATOWSIOFFEROR'S CERTIFICATION:1 hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national covemmentR]regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform tothe,terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if jamalarge quantity generator,)or(b)(if I am a small quantity genlor)is true. <br /> Generators lOfferars Photed[Typed Name Signature Month, Day Year <br /> (on behalf of the City of Manteca)L <br /> 16.International'Shomerits Export U.S. Port of entrI.V <br /> Import ❑to U.S, <br /> Trarsporler signature(for exports only): <br /> X 17.TransporterArawledgment of Reoeipt of Materials <br /> uj Signature Month Day Yeai <br /> III�2 -ra d Name <br /> 0 <br /> a- — <br /> in , --d N-ahe nature Month Day <br /> Yea <br /> QTransporter 2 PrintedrTy <br /> 1$.Dis+:repancy <br /> 18a,Discrepancy Indication Space Type F-1 Residue ElPartial Rojecdon ❑Full Refection <br /> QL'aruily <br /> Manifest Reference Nuriber: <br /> 186.Aitemate Facility for Generator) U.S.EPA 11)Number <br /> In <br /> LL Facility's Phone: Month Day Year <br /> CLI I tic.Signature of AltemYte—Facility(or Zenerator) <br /> L <br /> 3 mc; systems) <br /> 19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and recycling 4, <br /> —pcoer�Ied[T�"', <br /> ILL <br /> 2. <br /> onof receipt of hazardous materials covered by the manifest except as noted in item 183 <br /> IIfi <br /> 20.Designated Facility Owner or Operator: ertfi-ac <br /> Pn*cItTypiad Name Signature Signature th Day Year <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. tit Sri C t, TE D F-A VE IN AT f 13 N STATE.(IF' R E Q U I R I-D <br />