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F(T. Form Amoved.OMS No,20513_003� <br /> print or lype.(Form designed for 1 6(12-pitch)typewriter.} sponse Phone <br /> P eas"P e On I of 3.Emorgen e 4.M Hest Tracking Number <br /> + UNIFORM HAZARDOUS 1.Generator 10 Number 1 (900)424-9300 015481.747 JJK <br /> CAL000095996 — <br /> l WASTE MANIFEST <br /> Generator's Site Address(-if different than mailing address) <br /> s 'S.Ge orator"s Name and iling Address City of Manteca <br /> 1077 Milo Candini Manteca,CA 95337 <br /> City of Manteca <br /> Street,Manteca,CA 95337 <br /> 1001 West Center <br /> Germs <br /> Greg Showerman <br /> 7 <br /> Pal <br /> 1. <br /> 800�4�4_;s;00 <br /> 09)456-8415 Attn <br /> .......(2 U.S.EPA ID Number <br /> B.Transporter 1 Company Name 0 <br /> U.S,EPA ID Number <br /> �.Transputer 2 Company Name <br /> U.S.EPA 11)Number <br /> 8.Designated Facility Name and Site Address <br /> Buttonwillow Landfill <br /> 2500 West Lokem Road,Buttonwillow,CA 93206 CAD 980675276 <br /> (661)762-6200 <br /> s Phone: <br /> Facili t <br /> 10.Containers 11.Total12.Un' 13.Waste Codes <br /> 9a. 9L U.S.DOT Description(including proper Shipping Name,Hazard Gass,ID Number, Containers <br /> I've Quantity VIIVOI, <br /> No. <br /> and Padking Group(if any)) <br /> HM "ID'ype 7-1-1 <br /> to 18 Y <br /> i I.- NON-RCRA Hazardous Waste,Solids,(Lead) 001 D T <br /> UJ <br /> LU <br /> 3. <br /> 4. <br /> i,[.Special Handling Insmictions and Additional Information <br /> Soil: 95-100% Clean Harbors Profile Number:C H 13 12 3 0 7 B <br /> Vegetation:0-5% Wear appropriate Personal Protective Equipment as neo3ssary <br /> 15, GENERATOR'SIOFFERORIS CERTIFICATION:I hereby declare that the contents of this consignment are fully and accurately descried above by the proper shipping name,and are classified,packaged, <br /> marked and labeled1placarded,and are in all respects in proper condition for transport according to applicable iritemationa!and nationz I governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent <br /> I certify that the wa!eiomi=imizaffon statement identified in 40 CFR 26227(a)(if I am a large quantity generator)or(b)(if I am a small q jantity generator)is true <br /> Signature Month Day Y,7 <br /> GereratoesiOfferoes printedlTyped Name <br /> (on behalf of the City Of Manteca} I <br /> Shipments <br /> E1llmolort to U.S. 0 Export from U.S. <br /> Date leaving U.S.: <br /> Transpottersignature(for exports only): <br /> 17.Trawiler Acknowledgment of Receipt of Materials — I 011 <br /> Signature Month Day Y ar <br /> Transporter I PMtedITYPed Nane <br /> CL Month Day Year <br /> 03 7� owature L' <br /> Z ETran6-ordter PrjntedfFTypedN4m�e <br /> Cr <br /> cy <br /> 18a.Discrepancy Indication SpaceType Residue Partial Rejection Full Rejection <br /> Quantity <br /> Manifest Reference flumber. U.S,EPA ID Number <br /> 18b.Alternate Facility(or Generator) <br /> Month Day Year <br /> -Jac,Signature of Alternate Facility(or Gorteraloij <br /> W <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and—recycling systems) <br /> 3 <br /> UJ . <br /> fi I'ca i tion of receipt of hazardous materials covered by the manifest except as noted in Item Be <br /> 20,Designated Facility Owner Or Operator Month—Day YOU <br /> Printed/Typed Name <br /> T <br /> �-05) Previous editions are obsolete. A REQUIRED) <br />