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Form Approved,OMB No.2050-0033 <br /> designed for use on elite(12-pitch)typewriter.) ------ Manifest Tracking Number <br /> Response lliew,e print 0,type,(Fom des Emergency Res PhOr- <br /> ,ml or type. . .... <br /> I I�Generator ID Number 0 6 5 4 27 0 7-A-K <br /> UNIFORM HAZARDOUS I f- (800)424-9 rent than malting address) <br /> WASTE MANIFEST —AL000095996Generator s Site Address(if <br /> Generator's Name and Mailing,Address City of Manteca 'Ca'CA 95337 <br /> City of Manteca <br /> 1077 Milo Candird Dr'Ve,Manteca, <br /> n O'm oesigned for use on elite k�'/Vitulll <br /> HAZARDOUS U print <br /> o'tYpj1F <br /> UNIFORM <br /> WASTE M <br /> 100 i west center Street;Manteca,CA 95337 <br /> U.S.EPA 11)Number <br /> Generator's Phone: <br /> 6.Trans er ,mPa',Y 8me <br /> U.S. I Number <br /> EP <br /> 7.Transporter 2 Company Name <br /> U.S.EPA ID Number <br /> 8,Designated Facility Name and Site Addrass <br /> Buttonwillow Landfill CA 93206 CAD980675276 <br /> 2500 West Lokern Road,ButtOnwilllf)"V, <br /> FadlhysPwe: 661 10.Containers 11,Total 12.Unit 13.Waste Codes <br /> ga 9b.U.S.DOT DescriPticn(includirig Proper Shipping Name,Hazard Class,ID Nil"ribPr, No, Type Quantity VVtJVD1- <br /> HM 6 11 <br /> and Packing Group(i1 any)) <br /> 001 1)T 18 Y <br /> NON-RCRA Hazardous waste Solids Lead <br /> 2. <br /> 4. <br /> 14,Special Handling in <br /> structions.and Additional Inform— <br /> SoA! 95-100% Clean Harbors Profile Number:C H 13 12 3 0 7 B <br /> 0 KfiL�t v name, classified,packaged <br /> are fuilly���,rlbod above by the proper 51`11PPIng <br /> 15. GENERATOR'S,"OFFEROR'S CERTIFICAIJZ�-thereby d�edareth3t the�00n ents Of this consigement t and national governmental regulations.if export shipment and I am Me Primary <br /> 5 in proper condition for taftsi)Od according to applicable internatiOna <br /> marked and labeledlPlacarded,and are I"al'j respect a <br /> Expo ter,i car fy that the contents of this msliinment conform totf,' ten.,,Of the attached EPAAcknoWedgment of Consent, <br /> certify that the waste minimization statement t generator)is true. <br /> tidentilledin 40CFR 262.27(a)(if I am a large quantity generator)cr(b)(if!am a small quantic gene 41onth Day Year <br /> I <br /> Signature <br /> Generater'stOffen)l's Pf ntedrTyped Name <br /> ' 11 of Mariteca) <br /> I _"LV4'A�(On behalf of the Cit <br /> 1 VZA---eA 1E - <br /> 16..Intemal;onal.Shipments Export from U.S. Pon of ej. ry/exiL <br /> E,Import to U.S. Date leavi Ig U.S.: <br /> Transporter signature(for exports only): Month Day Year <br /> 17.Tran. ent of Receipt Of,Materials <br /> ,sporjerAokna�/,edgrn Sig t re <br /> Trans er 1 Printed/Typed Nam? <br /> Signature <br /> Tr orter 2 Prmledrryped Name <br /> 18.D� ,ancy Full RLKd <br /> 182,Discrepancy indication Space Q."tty ❑T YPO Residue Par'tial Refection <br /> on <br /> Manifest Referent e Num ter: <br /> U.S,EPA le Number <br /> 18b.Alternate Facility(or Generator) <br /> D,'5—anq <br /> 18..Discrepancy <br /> pancy ld,-h."Space <br /> "Fe"j, <br /> r18b Al�We, ty(or Generator) <br /> w FatiRty's Phone: Month Day Year <br /> ou 18C.signature of Aremate Facility i- <br /> Q <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes forhazardouswaste treatment.disposal,and recycling systems <br /> M U 1. 7- <br /> 20.Dasignated Facility Ovineror operator:Certification of receipt of hazardous materials covered by the rrwnoted ifestexcePt as Ot in It- <br /> 18a <br /> Montt! <br /> Signature Day Year <br /> f5MIedrryped Name L 117 <br /> EPA—Form 8700-22(Rev.3-05) Previous editions are obsolete. D GM f. 0 N�FAT E rflt' REQ Ir"L:c <br />