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Please print or type. (Form designed for use on elite (12 -pitch) typewriter) Form Approved. OMB No. 2050-0039 UNIFORM HAZARDOUS 1. Generator ID Number 1 2. Page 1 of 3. Emergency Response PhonManifest Tracking Number WASTE MANIFEST CAL000270082 11(800)e 4. 424-9300 0 0 7 6 3 7 7 6 5 FLE 5. Generators Name and Mailing Address Generator's Site Address (if different than mailing address) 7 -Eleven, Inc. 7 -Eleven 14113 P.O. Box 80741 3040 West Benjamin Hoff Drive GRa chooSanta Margaritane:, CA 92888 gq9 480-5200 Stockton, CA 95219 6. Transporter 1 Company Name U.S. EPA ID Number BELSH I R E CAR 000183913 7. Transporter 2 Company Name U.S. EPA ID Number 8. Designated Facility Name and Site Address U.S. EPA ID Number DeMenno Kerdoon CAT080013352 2000 N. Alameda St. Compton, CA 90222 310 537-7100 Facility's Phone: ga 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes HM and Packing Group (f any)) No. Type Quantity WtNol. 1. °C 0 x UN1203, Gasoline Mixture. 3, PG 11 G 13 z 2. W 3. 4. 14. Special Handling Instructions and Additional Information FOLD LABEL A ERGI 128 WEAR ALL APPROPRIATE 7-11 CCN: 813710 BES1:249326 I SIDE OF FIHA Gasoline &Water PROTECTIVE CLOTHING MATERIAL BILL X SS TAB snots of unwu orwrw 15. GEN ERATOR'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 intemational 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 EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a) (if 1 am a large quantity generator) or (b) Qi I am a small q0aTqy generator) is true. Generator's/Offerors Pdntedffyped Name tiignature Month Ua-y-7e-a-r Larry Moothart of BESI on behalf of generator J 16. International Shipments I- ❑ Import to U.S. Export from U.S. Port of entrylexit Z Transporter signature for exports only): Date leaving U.S.: w 17. Transporter Acknowledgment of Receipt of Materials tr Trans 1 Pnr led/Typed Name Signature Month Day Year QTransporter 2 Printed/typed Name Signature Month Day Year F 18. Discrepancy 1 Ba. Discrepancy Indication Spacety ❑ Type ❑ 1 ❑ ❑ QuantiT e Residue Partial Rejection Full Rejection Manifest Reference Number. 18b. Altemate Facility (or Generator) U.S. EPA ID Number J U Q LL Facility's Phone: W 18c. Signature of Alternate Facility (or Generator) Month Day Year Q z in 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) C V m 2. 3. 4. 20. ignated Facility Owner or Operator. Certification r ipt of ous materials covered by the manifest except as noted in Item 18a Prin yped Name Signature Day Year I Z<�� Z1,i?-V -6 EPA Form 8 00 22 (Rev. 3-05) Previous editions are obsolete./"'DESIGNATF6.FAM"TO DESTINATION STATE (IF REQUIRED) 11940.1340 r 00 '0 R EAR[ [ so T.