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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1 Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST C A L 0 0 0 0 4 5 9 2 3 1 1 (800) 424-9300 014687330 FLE 5.Generators Name and Mailing Address Generator's Site Address(If ditfemni.than mailing address) Quik Stop Markets, Inc- Quik StopMarkets, Inc. #125 165 Flanders Road 1580 W Main St. Westborough, MA 01581 Ripon, CA 95366 Generator's Phone: — 6.Transporter 1 Company Name U.S.EPA ID Number BELSHIRE T.Transporter 2 CRmparry Name U.S.EPA ID Number 8.Desgnaled Facility Name and Site Address U.S.EPA ID Number U.S. Ecn1agy Nevada Operations N V T 3 3 0 0 1 0 0 0 0 Highway 95, 11 miles S. of Beatty Beatty, NV 89003 Facility's.Phone: (775) 553-2203 9a 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 WLNol. 1 Non—RCRA Hazardous Waste, Solid (ERG #171) P 352 *DO1 (Rags, absorbent, S debris impacted with petroleum hydrocarbons) .J�J z 2. LU 0 3. 4. fOLD 14.Special Handling Instructions and Add t onal Informaton WEAR ALL APPROPRIATE BE S I -_ 3 1 9 2 8 5 LWE LABEL AT Ofl1TER LINE +ABEL%TD RIGHT Generator is a RCRA VSQG as defined in PERSONAL PROTECTIVE SIDE Of HAZA11DOUS 40 CFR 260.10. D018 code represents CLOTHING. QUIRSTOP CCN: 659237 MATERAL BILLS SO THAT waste that is RCRA identified but not TAB STiCISOW, RCRA regulated. PROFILE # 070214257-0 / S5Lcwwa+o-zr ' 15. GENERATOR'SIOFFEROR'S CERTIFICATION:1 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 EPA Acknowledgment of Consent certify that the waste minimization statement identified in 40 CFR 262.27(a)(ir 1 am a large quantity generator)or(b)(ifI am a small quantity generator)is true. Generator'sl0fferor's Printed/Typed Name Signature Month Day Year & , Gild �� ll .d _J 16.Intemabonai Ship e s F— ❑Import to U.S. Export from U.S. of anlrylexil: ? Transporter signature(for exports only): Dale leaving U,S.. W 17.Transporter Acknowledgment of Receipt of Materials LU Transporter 1 PrinW)T Name D `_ Signature M1ont_h Day Year z Transporter2 Pdrited/TyWIrame Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: F 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U ;� Fadlfty's Phone: w lift.Signature of Alternate Favi ty(or Generator) Month Day Year a z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systema) � : 1 ti. � 2 3. 4. 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a PrintedlTyped Name "Signature Month Day Year �r�ll 7 Zb EPA Form 8700-2 (Rev.12- 7) Prevlaus i0tIons are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM