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DTSC. 03822. 0368 Please print or type. (Form desianLd for use on eflle (12-oitchl tvoewrMer.1 Fnrt Annmvprl nruR Mn ')nuLAn'10 EPA Form 8700.22 (Rev. 3.05) Previous, t ons are obsolete. 12318.1246 DESJ5AfEDQRCr-rTO DESTINATION STATE (IF REQUIRED) I LA61 AFF OF ERIAL STICK Nu o+ UNIFORM HAZARDOUS 1. Generator ID Number 2. Page 1 of 3. Emergency Response Phone g Number Mang tTr WASTE MANIFEST C A L 0 0 0 2 7 0 0 8 2 1 1 800 424-9300 14. 8n 1 er �� 5. Generators Name and Marling Address Generator's Site Address (if different than mailing address) 7 -Eleven, Inc- 7 -Eleven 14113 P -O- Box 80741 3040 Wezt Benjamin Holt'Drive Rancho Santa Margarita CA 92688 Stockton, CA 95219 '949 Generators Phone: 460-5200 6. Transporter 1 Company Name U.S. EPA ID Number 7. Trax6wrter 2 Company Name U.S. EPA IDD Number 8. Designated Facility Name and Site Address U.S. EPA ID Number DeMenno Kerdoon CAT 0 8 0 0 13 3 5 2 2000 N- Alameda St. Compton, CA 90222 Facitil es Phone: 310 537-7100 ga, 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Gass, ID Number, 10. Containers 11. Total 12. Unit HM and Packing Group (il any)) Quantity W1Nol. 13. Waste Codes No. Type 1. Of UN1203, Gasoline Mixture, 3, PG II G 134 � x j \ l�Ni S z 2. w CD 3- 4. 14. Special Handling Instructions and Additional Information FOU WEAR ALL ArPROPRIATE B E S I• 2 6 9 0 5 4 UNI ERG;: 128 PROTECTIVE CLOTHING SIDI G23oline li Water 7-11 CCN: 613710 MAT TABL r77 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name, and are classified, packaged, marked and labeled/placarded, 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 Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAckmWedgment of Consent I certify that the waste minimization statement identified in 40 CFR 262.21(a) (if I am a large quantity generator) or (b) (I I am a sinal City generator) is true. enerator ernes Pfintedrryped Name Signature Month Day Year Larry Moot..hart of BESI on behalf of generator tx- -J f- 16. International Shipments Import to U.S. by ❑ Export from U.S. Port of en /exit Z TransloWer s' nature for exports only): Date leaving U.S.: W 17. Transporter Acknowledgment of Receipt of Materials F.- on ay ar ransportern pame g Z Transporter 2 Print yped Name t Signature `on ay ��prl► Year 1 `` 71 t l 18. Discrepancy 18a. Discrepancy Indication Space ❑ Quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Fufl Rejection Manifest Reference Number 18b. Alternate Facility (or Generator) U.S. EPA ID Number J U Facilitys Phone: LO 18c. Signature of Altemale Facility (or Generator) Month Day Year Q Z 0 dous Waste Report Management Method Codes (.e., codes for hazardous waste treatment, disposal, and recycling systems) w O RDesignated 2. 3. 4. Facility Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Yearl &0(n) EPA Form 8700.22 (Rev. 3.05) Previous, t ons are obsolete. 12318.1246 DESJ5AfEDQRCr-rTO DESTINATION STATE (IF REQUIRED) I LA61 AFF OF ERIAL STICK Nu o+