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Please print or type. Form Approved,OMB N6.2050-0039 UNIFORM HAZARDOUS 1,Generator IQ NumberA.Manifest Tracking Number 014683331 FLE' 2.Page i of 3.Emergency Response,RNone .WASTE MANIFEST CALO .0' 00459 (800) 4�!4—, 5.Generator's Name and Mailing Address Generators Site Address(It'diftererikthah mailing address) Quik 'Stop Markets, Inc. Quik stop Markets, lhr-- 165 Flanders- Aoad 1580 Iq Main St. Westborougli, MA 01581 Ripon, CA 95366 Generators Phone: 2,2 2 21 6,Transporter 1 Company Name U.Sr EPA ID Number :C a 0 q (A 1 q 7,Transporter 2 Company Name U.S.EPA IO Number 8.Designated Facility Name and Site Address U.S.EPA ID Number World 'Oil. Rec Cding' CAT080 013352 2000, N. Ala 90 Compon, .Facility'sPht6ne: CA 222 (310) 537-7104 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(if any)) No. Type Quantity wt.Nol. 1. UN1203, Gasoline Mixture, 3, PG II G 134 0 X Z) 2, LU 3. 4. -ArSpedal Handling Instructions jand Addiliqlrial Information WEAR ALL APPROPRIATIZ BESI : 319 2 8,Pj t` LrRGi�1 128 PERSONAL PRQTECTIVE HAWZA Gasoline & Water CLOTHING. QUIKS7.013 CCN: 659237 15, GENEPATOITVOFFERORIS CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,6@ areslassl6d;,pack6ged, marked and labelediplacarded,and are in all respects in proper condition for transport according to applicable International and national governmental regulaii6ris,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 GFR 262.27(a)(if I am a large qy@nUty generator)or(b)(iff am a small quantity generator)is true; Generator's/Offeror's Printedrryped Name Signature Month Day Year 16.International 34)mdrits I 1 11 import to U.S. ❑Export from U,S, Transporter signature(for exports only): Date leaving U.S.: �A7,transpo'her Acknowledgment of Receipt of Materials Wu 12 Transporlbr i Pdn<Typed Name Signature Month Ddy' Yea 0 I.Q j 1 20 CL Transporter 2 Printed/Typed Name Signature Month Day Year 18,'Discrepancy 18ftiscre'pancy Indication Space El Qua 0 Type ❑Residue El Partial Rejeclld� ❑Full Rejection .Quant Manifest Reference Number: 18b.Alternate Facility(or Generator) U,8.EPA ID Number uQ Facility's Phone: U, 18c.Signature ofAlterriate,Facility(or Generator) Month Day !Year 19,H port Management Mdthod Codes(i.e.,codes or hazardous waste treatment,disposal,an recyc ng Systems). Ordo s., ste Re in Ly 1. 2. T- 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a A PdntedffMd Name Signature e-mMont Day, Year I - EPA Form 8700-22(Rev.12-17) Previous editions are obsolete, DESIGNATED FACILITY10 EPA's e-MANIFEST-'SYSTEM