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Please print or type. Form Approved,OMB No.2050-0039 UNIFORM HAZARDOUS I 1 Generator ID Number 2 Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST CAL 0 0 0 0 4 3 3 4 1 1 (800) 424-930001-9320309FLE 5.Generator's Name and Meiling Address Generalors Site Address(if different than maiift address) Quik Stop Markets, Inc. uik Stop Markets, Inc. #132 165 Flanders Road 555 W. Hammer Ln. Stockton, CA 95219 West orough, MA 01581 Generator`s P e: C�I tj d A 6.Transporter 1 Company Name U.S.EPA 10 Number BELSHIRE CAR 0 0 0 1 8 3 913 7 Transporter 2 Company Name U.S.EPA 10 Number 8.Designated Facility Name and Site Address U.S.EPA ID Number U,.S Ecology, Nevada Operations NV T 3 3 0 0 1 0 0 0 0 Highway 95, 11 miles S. of Beatty 441, NV 89003 (775) 553-2201 ga. 9b.U.S"DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers it Total 12.Unit HM and Packing Group(if any)) No. Type Quantity WtJVol. 13.Waste Codes 1 Non-RCRA Hazardous Waste, Solid (ERG #171) DM F 352 DQ19j Fo (Rags, absorbent, & debris impacted with petroleum hydrocarbons) z 2 w CD 3 s l 4 t I 14.Special Handling Instructions and Additional Information WEAR ALL APPROPRIATE HE$I • 3 G 4 G O 9 Generator is a RCRA VSQG as defined in PERSONAL PROTECTIVE - 40 CFR 260.10. D018 code represents CLOTHING. OUIKSTOP CCN: 659237 waste that is RCRA identified but nc,t RCRA related. FRdFILE # 070214257-0 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. 1 certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a kvge quantity generator)or(b)(if I am a small quantity generator)is true. rGen erator's/Offeror's Printed/Typed Name Signature Month Day Year BALM j 16.International Shipments F ❑Import to U.S. ❑Export from U.S. Part ofentry/exit: ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Primed(Typed signature \ Wnth Day Year Z Transporter Printed/Typed Name Signature Month Day Year H 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 U LA- Facility's Phone: w 18c Signature of Alternate Facility(or Generator) Month Day Year Q z 5 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) LLI t. 2 3, 4 20.DesignIdlacility Owner or Operator:Certification of receipt of hazardous materials covered by the mania except noted in Item 18a Printed/Typed Name a Month Day Year 19 11-7 EPA Form 8700-L2 v.12-17) Previous edition ere obsolete. DESIGNATED FACILITY TO EPA's e-MMIFEST SYST M 132/3510391