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Plcase print or type.(Form cia*n rd for use on elite(112-pitch)rypewriler.) Form Approved.WAB No.2050-0039 <br /> UNIFORM HAZARDOUS I.Generalur ID Number 2.Page 1 of 3.Emergency Response Phone 14.Manifest Tracking Number <br /> WASTE MANIFEST CAL000225724 1 800-424-'x300 1004234187 FLE <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different Than mailing address) <br /> SP W;?5t Coast Products, LLC 02186 <br /> P.O. Lox 50249 3212 N CALIFORNIA <br /> RRan�a oanta i.largarita, CA 02688 STOCKTON, CA 95204 <br /> G'enuraGir'.sYhone. 949 4$0 000 <br /> Transporter6. Company Name U.S.EPA ID Number I <br /> BELSHI RE CAR0001839-13 i <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> B.Designated Facility Name and Site Address U.S.EPA ID Number <br /> DeMenno Kerdoon <br /> 2000 N.Alarneda 5t. (CAT080013352 <br /> CA 90222 _ Z7_ <br /> ga. 91b-U.S.DOT Description(ndufing Proper Shipping Name,Hazard Class,ID Number, 10.Contalners 11.Total 12.Unit <br /> HM and Packing Group(If any)) No. Type Quantity WINol. 13.Waste Codes <br /> 1. <br /> 0 UN1203, Gasoline Mixture, 3, PCs II �-I.. 1.^_•d <br /> � G <br /> z z. <br /> w <br /> t7 <br /> 3. <br /> 4, <br /> 14.SpecralHandling lostnxtbnsand Additional Information \& AR ALL APPROPRIATE $ESI:1 89030 n a <br /> ERGO- 12B SELSHII?E CCN: p <br /> Gasoline tV�later PERSONAL PROTECTIVE 205882 t <br /> I x 5 3 EQUIPMENT. BP CCN: <br /> 205883 <br /> 15. GENERATOR'SIOFFERDR'S CERTIFICATION: I hareby deckire that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlplacarded,and are In all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of]his consignment conform to the terms of Inc attached EPAAcknowkbgment of Consent. <br /> I cedily that the waste minimization statement idenlifed In 40 CFR 26227(a)Qf I am a large quantity generator)or(b)(H I s II quantity generator)is true. <br /> GeneraWsl0flemes PmdWypod Nam swalure Mw <br /> ay You <br /> Larry Moothart of BEST on behalf of venerator <br /> 16.international Shipments <br /> ❑Import le U.S. ❑Export fro Port of entrylexit <br /> Z Transporter sinature for exports onl : Dale lea U.S.: <br /> IX 1T I ransporterAcknowledgment of Receipt of Materials <br /> rrwspo W1 nledlfNam Signakwo Month Day Year <br /> CL <br /> Transporter 2PrintodfrypedNa o 5imm1w In Uay Yet <br /> 18.Discrepancy <br /> 1 W.Discrepancy Indication Space ❑Quat'lly Type ❑Reskfue Partial ReJcliII�11 <br /> Full Rejection <br /> Manifest Reference Number: <br /> I&Altemele Facility(cr Gencrolor) U.S.EPA ID Number <br /> U <br /> Q <br /> LL Fel s Phone: <br /> In 18c.Signature ofNfernate Facltity(or Generator) MoNh Day Year <br /> Q • <br /> Z <br /> W19.Hazardous Waste Report Management Method Codes(Le,,,codes for hazardous waste bealmerd,d'aposal,and recycling systems) <br /> T. <br /> 4. <br /> I <br /> EDignated Fac811y Owner or Ope(ator:Cartigcation of receipt of hazardous materia s covered by 0 e manliest except as noted in Item i8a <br /> Ryped Name Signature Month Day Year I <br /> I <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE JIF REQUIRED) <br /> " I <br />