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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 Trackin Number WASTE MANIFEST Cab 0 0 0 0 4 3 3 4 1 1 (800) 424-9300 018§2 7 8 8 6 F L E 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) Quik Stop Markets, Inc. ik gt Narke a, Inc. #132 165 rlanders Road 55 M. HaCA r O Westborough, KA 01581 Stockton, C!, 9�2i 9 Generator's Phone: 51 445-2232 6.Transporter 1 Company Name U.S.EPA ID Number RELSH IRE C A 8Z 0 0 01.3!13 7.Transporter 2 Company Name U.S.EPA ID Number I 8.Designated Facility Name and Site Address U.S.EPA ID Number i World coil Recycling CAT 0 #0 013 3 5 Z 2000 N. Alameda St. tG11, CA 90222 (310) 537-7100 Facility' hone: 9a, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit HIM and Packing Group(if any)) No. Type Quantity Wt.Nol. 13.Waste Codes 0 x 1. ON1203, Gasoline Mixture, 3, PG 11 G 134 �a W 2. C9 e i 3. I l 4. i 14.Special Handling Instructions and Additional Information MAR ALL ALL All" I"TERMG# BESI : 356831 c>saro=iytnes� waterPIMSONAL t CTIVR CLOTRING. QVIUTOP CCU.. 659231 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,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 EPAAcknowledgment 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)(ifI am a small quantity generator)is true. Generators/Offerors Prinied/Typed Name Signature Month Day Year l 16.International Shipments H p ❑Import to U.S. ❑Export from U.S. Port of entry/exit: M Transporter signature(for exports only): Date leaving U.S.: OC 17.Transporter Acknowledgment of Receipt of Materials LU Transporter 1 Printed(ryped Name Signature Month Day Year Z Transporter 2 Printed/Typed Name Signature a Month Day Year 18.Discrepancy i 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residue j j❑Partial Rejection El Rejection Manifest Reference Number: t 18b.Alternate Facility(or Generator) U.S.EPA ID Number rJ I LL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year i Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 2. 3. 4. y 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered the manifest except as noted in Item 18a PrintEldfTyped Name Signature w.r ti} t�y Y r h EPA Form 8700-22(R .12-1 ) Previous editions are obsolete. TRAN19POkIER CO Y 132/3284892