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Please print or type. -7016572910 Form Approved,OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator 10 Number 2.Page 1 of 3.Emergency Response Phone 4.Mantras(Tracking Number WASTE MANIFEST C A L 0 0 0 0 4 5 8 9 9 1 (800) 424-9300 016 5 7 2 910 FLE 5.Generators Name and Mailing Address Generators Site Address(if different than mailing address) Quik Stop Markets, Inc. Quik Stopp Markets, Inc. #076 165 Flanders Road 1030 S. DlCAve. A Westborough, MA 01581 Stockton, CA 95215 Generator's Phone: 510) 445-2282 6.Transporter 1 Company Name U.S.EPA ID Number sELSHIRE CAR 0 0 018 3 913 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number World Oil Recycling C A T 0 8 0 01 3 3 5 2 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(if any)) No. Type Quantity Wt.Nol. X 1' UN1203, Gasoline Mixture, 3, PG II G 134 ` L 2. I 3 .... r 4. 14.Special Handling Instructions and Additional Information WEAR ALL APPROPRIATE FOLD LABEL T DOTTED ERG#: 128 PERSONAL PROTECTIVE BEST : 3 3 4 2 8 3 LINE, AFFIL(TO HAZARDOHS OUS Gasoline & Water CLOTHING. QUIKSTOP CCN: 659237 SIDE OF SILLS HAT MATERIAL BILLS 80 THAT' /X 55 .,.0TA8OUT. 1Mu*t 01991 wuhvrR*(� 1 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,arca 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 EPAAckrowledgmenl of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)lift am a small quantity generator)is true. rtor'stofferors Printed yped Name Signature Month Day Year W011 �� (5 2- r 116.International Shipments ❑ --- Transporter _Import to U.S. Export from U.S. Port of entry/exit:__ Transporter signature(for exports only): Date leaving U.S.: 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Prinledfry Name Signature '�(� Month Day Year N Transporter 2 Prinledrryped Name Signature Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J_ V LL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year 2 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) D 1' 2 3. 4. F�� ity Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Signature Month Day Year EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM