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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 1 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST C A Ta 0 0 0 4 6 6 5 9 2 I `($00) 424-9300 018927915 FLE 5.Generator's Name and Mailing Address Generator's Site Address(d different than mailing address) 7-Eleven, Inc- 7-Eleven 38616 P.o. Box 80741 601 Carolyn Weston Blvd. Rancho Santa Margarita, CA 92688 Stockton, CA 95206 Generator's Phone: (q491 4f;Q-1;2QQ1 6.Transporter 1 Company Name U.S.EPA ID Number BELSHIRE CARO 0 018 3 91.3 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number World Oil Recycling CAT 0 8 0 0 1 3 35t 2 2000 N. Alameda Ste on, CA 90222 Far4yn (310) 537- g ga. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13 Waste Codes HM and Packing Group('d any)) No. Type Quantity Wt.Nol. o X 1 UN1203, Gasoline Mixture, 3, PG II G 134 z 2. W C7 3. 4. 14.Special Handing Instructions and Additional information WEAR ALL APPROPRIATEN EtiG$-. 12t) PROTECTIVE CLOTHING �L"'�Y ' ��'3 j� 01I Gasoline 5 water 7-11 CCN: 613710 l i X p op 15. GENERATOWSIOFFEROR'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.N export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAclmowledgment of Consent r I certify that the waste minimization statement identified in 40 CFR 262.27(a)(d I am a large quantity,generator)or(b)(HI am a all ntity generator)is free. Generator's/Offeroes Printed/Typed Name Signature Month Day Year Larry Moothart of BEST on behalf of generator '7 12517-3 16.International Shipments F ❑Import to U.S. ❑Export from U.S. Port of entry/exit ? Transporter signature(for exports only): Date leaving U.S.: IX W 17.TransporterAckmowledgment of Receipt of Materials Transporter 1 Print Name Signature Month Day Year Z Transporter 2Pnnted/Type ame Signature MonthDay Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Typ e ❑Residue ❑Partial Rejection El Full Rejection Manifest Reference Number. 18b.Alternate FaclGty(or Generator) U.S.EPA ID Number V LL Facility's Phone: LLJ 18c.Signature of Akemate Facility(or Generator) Month Day Year Q Z y19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) C 1. 12. 3. 4. 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest except as Wed l9poltern 18a Print Name Signature Month Day Year d3 EPA Form 8700-22( 12-17) Previous editions are obsolete. ESIGNATED FACT TO EPA's e-MANIFEST SYSTEM