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r= - <br /> Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST C ,A L 0 0 0 0 4- 5 9 S z (800) 424_9300 017535317 FLE <br /> 5.Generator's Nara and MailikAddress Generator's Site Address(if different than mailing address) <br /> guile Stop Markets, Inc. o 7? = Markets, Inc. 6144 <br /> 165 Flanders Roar <br /> Westborough, LEA 01581 Stockton, CA 95210 <br /> Generators Phone: (510) 4 4 5-22 82 <br /> 6,Transporter 1 Company Name U.S.EPA ID Number <br /> BP-L SHI CAR 0 0 0 1 3 9 1 3 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> C 4T of&Z <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> World. Oil Recycling C .T O G O O 1 3 3 5 2 <br /> 2000 N. Alameda SG. <br /> Compton, CA 90222 (310) 537-7100 <br /> Facility's hone: <br /> ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> HM and Packing Group(if any)) No. Type Quantity Wt./vol. 13.iiWaste Codes <br /> 1 UN1203r GasolineMixture, 3, PG 11 � DM G 134 <br /> o <br /> W 2. <br /> f <br /> i t <br /> 3 ` <br /> 4. <br /> FOLD'LABE< T n <br /> 14.Special Handling Instructions and Additional Information I <br /> WEAR ALL APPROPRIATE ��I . 34 662 (5 .LINE AFFIX;TO;RIG <br /> ERGO: 1zS PERSONAL PROTECTIVE � � SIDE OF HAZAROOj <br /> Gasoline t Water CLOTHING. QUIKSTOP CCN: 659237 MATERIAlBItLSSOTH <br /> 1 TAB SiiCKS DllT <br /> �`ZT196U®Y947�`}aea�ltsiiil <br /> 15. GENERATOR'S/OFFEROR'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, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable internationaland national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if I am a small quantity generator)is true. <br /> Genera eslOfferoes Printed/ryped Name n< Signature Month Day Year <br /> 16.International Shipments <br /> H El Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> w 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 PrintedfTyped Na Signature Month Day Year <br /> Aa U <br /> cmn Transporter 2 P ted/Typed Name Signature Month Day Year <br /> z <br /> 18,Discrepancy <br /> 18a.Discrepancy Indication Space 0 Quantity ❑Type El j j Residue ❑Partial Rejection Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facility's Phone: <br /> w 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> S2 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> C 1. 2. 3. 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Pdnted/Typed Name Signature M n Da Year <br /> pil le <br /> EPA Form8700-22(Rev.12-17) Previous editions are obsolete. 144/2974407 DESIGNATED FACILITY TO EPA'se-MANIFEST SYSTEM <br />