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Please print r- (Form designed for use on elite(12-pitch) tet) Forth Approved.OMB No.'2050-0039 UNIFORM HAZARDOUS 1 1.Ganervbr ID Number 2.Page 1 of 3.Emergency Response Phare 4.Manifest Trwking Number WASTE MANIFEST C A L-0 0 0 0 4 5 9 4 0 1 0 368-4778 1006053802JJ K 5.Generators Name and Malang Address Generators Site Address(Idhlerent than ma&V addreta) QLnK STOP MARKET#152 1721 SOUTH CHEROKEE 5T- 4567 ENTERPRISE 5T 240 FREMONT 510 t�7 5500 CA 94LODI CA 95 Generabors Phare: Transporter 1 CwVany Nemo U.S.EPA ID Nurtbar ENVIRONMENTAL RECOVERY SERVICES,INC. C A R 0 0 0 1 8 8 2 0 1 7. raralwar2 CompanyName U.S.EPAI MkUMEE EXPRESS(LD.47778 N J D$8 0 6 0.7 3 8 0 8.Designated Fr.My Name and Site AWrm U.S.EPA D Number RINECO t007 VULCAN ROAD-HA5KELL BENFavi tys�nQN ) � AR 72(715 A RD 8 8 10 5 7 870 0 ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,D Nunbar,. 10.Containers 11.Total 12 Unit HM and PadLYg Group(if any)) No. Type Quantity ".Nal. 13.Walla Cods X 1. WA5TE 50LID5 CONTAINING FLAMMABLE LIQUID,MO.511 4.1,UN3175,PGII D001 0018 352 (GASOLINE,BENZENE) 1 D M 75 P 2. 3. 4, 4.Spadet Handling Instructions,and Addbmai InlomMon N110907-1--GASOLINE SERVICE PUMP DEBRIS ERG4:981. 193'ERS W.OASM-ECB••CONTRACTOR NANO TECH ENVIRONMENTAL•. BILL TO ENVIROSERV-WEARPROPER PPE 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the conlarls of this cor*nmeni are fuay and amntsy desalted above by the proper shglog name,and are dassMed,packaged, marked and labeledlplacarded,and are in au reagens in proper condition for hansport accorf9 to appticable International and national governmental regulawns.If export shipment and I am au Nftwy Exporter,l cer*that the extef a of this ronsig meat conform to the terms of the atbacW EPA Ack wwiadgmerd of Consent. 1 artily that the waste minimozabon statement klentillad in 40 CFR 26227(a)(If I am a large quantity generator)or tb)(d true.I am a smal quantity germs"is tn . Generalorsl0lferoes PrfnaWyped Name_ Sign&re MV. S F 16.bltemaaonLal Shipments ❑knpoR v U.S ❑Ext rt hon U.S. Port of entryteldl: Transporter signature(for exports only): Date leaving U.S.: U', 17.Transporter Acknowledgment of Recdpt of Materials O Trarsp r 1 ar yp Signature Month Day Ya IL t 7 �Y 49 COO 1 TranspoAer yped Name Sg Mordh Day Year cc yl 18.D 30*Wncy 18a.DLsaepancy Indication Space 11 Q�dy []Type ❑Residua ❑PaNai Re)ecBaL ❑Full Rrgacton Manifest Reference Number. 18b.Akemsta Facirdy(or Generator) U.S.FPA D Number U ua Fediys Ph r.: W 18c.Signature of Altemats Facility(or Generator) Mond1 Day Year a y19.Hazardous Uh Report Management Method Codas Q.e.,codes for hazardous baste trea4lent,disposal,end recycling apt"), c 1. 2 3. 4. 20.Designated Faaliry dvrw or operpr CerGflcation of receipt of hanudous materials covered by the manifest ezcapt as nded In Reif8a g' yptd Name Signature y EM-Form 8700.22(Rev.•3-a5)'Previous editions are obsolete. DESIQ ED FACIL O DESTINATION STATE(IF REQUIRED) �>G� ur.. _. ..