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Pivase print or type.(Form designed for use on elite(12-pitch)typewriter) <br /> ~ UNIFORM HAZgRpt)Ug i.Generator ID Number <br /> t WASTE MANIFEST L 2.Page i of 3.Emergency Response phone Forrn Approved.OMB No.2050-01)39 <br /> 0 9 5 9 9 6 4.fAanitest Tracking Humber <br /> 5.Generators Name and Mailing Address 1 ($Ot7)424.9300 I= <br /> '( L^ ry—p�-y <br /> CitY Of Manteca Generator's Site Address(Ndifarent than mailing address) G ( �j <br /> 1001 West Center Street,Manteca,CA 95337 City of Manteca <br /> Generators phone: 209 456 $415 Attu:Gre Showermati 107?Milo Candiru I hive,Manteca,CA 95337 <br /> 6.Tran s^iter i Companyr�Naamme <br /> U.S.FPA 1-0—N umber <br /> Transporter 2 Company Name v f{'/J P ,..,o a L .q <br /> U.S.EPA ID Number ¢j <br /> 6.Doses;atod Faci9ty Nama and Site Address <br /> i ButtOnwZllo%r Landfill t U S EPA!D Number <br /> 2500 West Lokern Road,ButtonwiUow,CA 93206 <br /> Fadlitys phone:(661)762-6200 <br /> .}a, 9b.U.S.COT Description(including Proper Shipping Name,Hazard Class,ID Number, CAD 9$0 6 7 5 2 7 6 <br /> I?M and Packing Group(if any)) 10.Containers --- <br /> 1. 11.Total 12.Unit <br /> t< No. Typ; QuantityWt.Nol, 13.Waste codes <br /> E? <br /> °i <br /> NON'-RCRA Hazardous Waste,Solids,(Lead) 6 1 1 <br /> `2f 0 01 2. <br /> U; H T 18 Y <br /> i <br /> f <br /> 6 t <br /> 3 --4 <br /> r t <br /> i <br /> 4. <br /> i <br /> 14.Specie!Handling Instructions andAdditisnat IntomuGon � i <br /> i <br /> soil: 95-100% r <br /> Clean Harbors profile Number:C H 13 12 3 0 7 B <br /> 'Vegetation:0-5% Wear omiate Pers <br /> orW F. GENERATQR"5lQFFERt}R'S CERTIFICATION;!hereby declare that the contents of this crm0 gn�r�nt are fully and accurately esdescribed� a�tx ye b the <br /> _racked and labeled/placarded,and are in all respects in proper condition for Iran <br /> sport accentingto g } 9 Per shipping name,aril are classified,packaged, <br /> :xporter,!certify that the contents of this consignment conlorm to the terns of the afartod EPA Acknowledgment of Cownt. <br /> knowledg in of iional and rational overnr.ental re v at ons.if export shipment and!am the primary <br /> certify that the waste min mization statement identified in 40 CFR 262.27(a)(if I am a targe q"'tty generator}or(b)(If i am a small quantity generator)is true. <br /> (:operator s101Fero�s Pr ntedtTyped Namo <br /> r' 1�l G-s� 1`sc�tlL--lZf�/ Signature <br /> {on behalf of the Cyty ofh3araeca) Moron Day Year <br /> tnfsrna±'opal Shipments / � <br /> ILJ Import to U.S. <br /> T anspar or Signature(for exports ora y) Export from U.S. <br /> xp° Port oftrytexil-_z <br /> W I"TransporterAcknowledgment of Receipt of ffiatahals Date leaving U.S.: <br /> T ansp<<cW 1P.. Name y <br /> f,-/�.../ / Signature <br /> Za Month Day Year <br /> Trrnspc:rter2PrintedffypedName -� <br /> ~ <br /> Sig <br /> Month ay Year <br /> 18 Discrepancy i <br /> 18a-Discrepancy indication Space <br /> Ouant!ty FIType L_J Residue r---� <br /> _I Partial Rejection ❑Full Rejection <br /> _ 18. .Nternata Facility(cr Generator) Man;test Reference Number: <br /> "s U.S.EPA ID Number <br /> U <br /> Fac!4 sPhone: <br /> U. r <br /> 18x,S grature ofRtemate Faality(or Generator) <br /> Month Day Year <br /> Z _ <br /> 7 <br /> 07 <br /> iazaidous Waste Report Management Method Codes(i.e.,codes for hmrdous waste treatment,disposal,and recycling systems) <br /> CLUj 1 � 2. 3 4 r <br /> 20,i7esigoatad Facility Owner or Operator.Certification a`receipt of hazardous materials covered)y the manifest <br /> except as noted to Item 183 ? <br /> prneddfTyped Name Signature Month Day Year <br /> EPA Fonn 8700-22(Rev.3-05) Previous editions are obsolete. F! f t e'l rT: !`t' F1ESTIh til "_( }F rEtFIQIlIEt?c <br />