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Please prin).or type. Farm Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTE MANIFEST C R L 0 0 0 0 4 5 0 3 5 1 1000) 424-9300 1 13:174F L E 5.Generator's Name and Mailing Address Geenneerratoes Site Address(if different than mailing address) Quik Stop Markets, Inc. T2 �top Markets, Inc. #144 1 165 Flanders Road ';In) AAS-92221 s W Cut, �. 95210 �t on fought MR 01581 Genera or's one: 6.Transporter 1 Company Name U.S.EPA ID Number BELSHIRE CARD 0 019 3 O 13 7.Transporter 2 Company Name U.S.EPA ID Number 8.Designated Facility Name and Site Address U.S.EPA ID Number World Oil Riesyyccling CJLT O B 0 O 13 3 S Z 2000 N. Ali mM d St. , !"i CA 9=2 (310) 537-7100 ga 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HIM and Packing Group(if any)) No. Type Quantity Wt.Nol. c X 1 UN1203, Gasoline Mixture, 3, PG II 13K G 134 z 2. L O 3. 4. I 14'.Special Han_ing Instructions and Additional Information ,ter: �28 W P FSI: 366000 I �+h�oline a rater CL0rHM4G. QUIXOTIOP CM% 659237 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, 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 EPA Acknowledgment 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)(if I am a small quantity generator)is true. Generator's/Offeror's Printed/Typed Name Signature Month Day Year 16.Intemational Shipments H ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: OC W 17.Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year O Z Transporter 2 Printed/Typed Name Signature Month Day Ye at 1 F i 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantit y El Type ❑Residue El Partial Rejection El Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J i LL Facility's Phone: W 18c.Signature of Alternate Facility(or Generator) Month Day Year Q ! I Z I N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) j C 1. r 2. 3. esignated F 'I Owner or Operator: rtification of receipt of hazardous materiaf covered by the manifest exceptA noted in 1048. 4Jnt /TJd Signature n r/00-2 ev.12-17) Previous edi ions are obsolete. TRA S 0R R CO Y 144/3534300