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Please print or type,(Forts designed'or use cm elite(12-pitch)lypewriler,! Form Approved,VAB No,2050-0039
<br /> UNIFORM HAZARDOUS 1.t cnan;Lf um- r 2.Page ^i u. mer icy Resp se Prone 4.
<br /> WASTE MANIFEST CA 1,000 09 5 991 1 (800)424 016542709 JJK-
<br /> 5,Generator's Name and Maiil;pg Address, Genpratur's Sire Addiess i4differentihar majhrigaddrossj
<br /> City of Manteca City of Manteca
<br /> 1001 West Center Street,Manteca,CA 95337 1077 Milo Can&yi Dfivrejklanteca,CA 95.137
<br /> pnone�(?Oql A 6-R41 5 Attn, 9how-miar
<br /> EP 10,filume-r
<br /> Tran acres 70
<br /> 2 Company Name Numi',e,
<br /> s.Designated Faclq Name and Site Address U.S:---PA 1 D N u n ipe r
<br /> Buttonwillow Landfill
<br /> 2500%Vest Lokerii Road,Buttonwillow,CA 93206
<br /> CAD980675276
<br /> I 's Pt�wu�(660 762-6200
<br /> RX ).S. lo'cludmo Pro�r hi r�nng Nme,Hazar i,--tasz,ID N1 1 1.Total Q.Unit 11,Waste codes
<br /> Pe 8 p, conwitefs
<br /> --T fTYPP
<br /> t,4' �ns Gmup(I any Quantily
<br /> 611
<br /> NONI -RCRA Hazwdoms Waste.Soficls-,(Lead) 001 DT 18 Y
<br /> 2,
<br /> LU
<br /> 4,
<br /> Soil: 95-100% Cly an Harbors Prefile NurnIvr: C 111 31 21 3 0
<br /> Ve2etation:0-5% Wear amrgph -
<br /> �ate Perioral Protective Eullij=ent a.5 nCCeS.WV
<br /> Ii GENERATOR'VOFFEROR'S CERTIFICATION: I hereby derDare that the cantents of this consignnent a'e fluily and accjrinety riesonbed above by the grout shipping name,and are classified,pa aacied,
<br /> marke, w - -s,if axpo'shipmr?,and I arintne Prim-afy
<br /> , i and hibeli,a,'aacxded,andare pr3por coriditicn for triuspolri accPoling zo appl,,cabte ii- ':a;-aabc-naland rodi,,pal rcgalist-n
<br /> Expa'tes rt n Fame Contents of fas consign rart ccr�form to the tern is of thr-alta-,hed EPAA&,now1ddqment of Consent,
<br /> ceriy n a,v e waste minirniza"'Onstaterne'rit identified in 40(;FR 262.2 27(a)lif I am a'�rge quantay oe-riefatot)or io)i�f 11 am a small quantily r
<br /> a ge^rsiatoiii is'>-ue.
<br /> Prir*Aed=Tvnat Nami Signature Month Day Year
<br /> -:�=- — I I I
<br /> I
<br /> (on behalf of the City of Maiteca)
<br /> Lj imeort tc.U.S, Export from U.S. Per;of Ipt taxa ------------- —-------...........
<br /> gl-r exisons on:yi: Date lea,j g S"
<br /> L!OF '17
<br /> Traris'po-ta,I PnntedJyped Name Signature 'Month Day Year
<br /> TraMomlu Da Y�ar
<br /> P-,,; e,2 Name
<br /> EC
<br /> irs,DisrInpa-cy Ind-calon SDa"s F J 1 �iype Residuis E1 Partai Refe-son L,Fuli Pailrd'Dil
<br /> L.
<br /> Numr r-
<br /> 1,81b,Alternate--adlilv(o,Generale,) U,S,EPA ID Number
<br /> c:1 7�.,Sig,afm DiAftemitt-=Facility(o,Generators Morth Day Year
<br /> Uj
<br /> "'j.Hazard)us;V"aste Report Management Kle!nod Codes ii e.,codas for hazars us*asre treatinvit and racycErIQ tenis)
<br /> En
<br /> U4 Z 4,
<br /> 2LI DesignaiEd Facility Gvvner v Operator:Cem"icaton of teceipI of hazardous matelmio cowcA till llfie.ria a"1test exceNt as ndel in ham 18a
<br /> Flaed Nme signatwe Ninth Day Year
<br /> ERA Fo-m 8700.22 IRcv,3-005) P'-- cditions are obsolete. FACIATY TO DESTINATION STATE OF REQUIRED)
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