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Please print or type.(Form designed for use on elite(12-pitch)typown(ec) 4--- Form Approved,DMB No.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Paso 1 of 3.Emo gency Response Phone 4.Manifest TrackiNumber <br /> WASTE MANIFEST CAT 0 0 0 6 1 8 6 3 7 1 (800)424-9300 0 0 5 1 7 9 8 4 4 FLE <br /> 5.Generator's hams and MalBrp Address Generatoes Silo Address(d d ilerent than malling address) <br /> Tesoro Stockton Terminal Tesoro Stockton Terminal <br /> 3003 Navy Drive 3003 Navy Drive <br /> Stockton, CA 95206 (209)466-8800 Stockton, CA 95206 <br /> Generabr's Phone: <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Nieto and Sons Trucking, Inc. C A T 0 8 0 0 1 6 1 16 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> B.Designated Facility Name and Site Address U.S.EPA ID Number <br /> DeMenno Kerdoon <br /> 2000 N.Alameda Street <br /> Fa Moon, CA,90222 (310)537-71000 8 0 0-13352 <br /> go. 9b.U.S.DOT Description'(Induding Proper Shipping Name,Hazard Class,ID Number, W.Containers 11.Total 12.Unit <br /> FBA and Paddng Omup 0 any)) No. T Quantity MJVDL 13.Male Codas t <br /> I <br /> 1. <br /> O 434 , <br /> UN 1203 Gasoline Mixture 3 PGII 0 0 1 T T <br /> w 2' <br /> 3. E C 8 2 15 <br /> t <br /> 4. ENVI NMI NTAL EAL <br /> 14,Special Handling Instructions and Addillonal lnfonnabon ti"4- i <br /> Gasoline&Water MixtureFab <br /> �' r. <br /> Wear All Appropriate E.R.G,#128 BESI P.O.#228083 <br /> Protective Clothing Tesoro CCN 618330 <br /> iii. GENERATOR'StOFFEROR'S CERTIFICATION: I hereby dedare that the mntertta of this coreslgument ere fully and eccurdteiy described above by the proper shipping name,and are classified,packaged, <br /> marked end labeledlplacardod,and are in all respacis!n proper Gond ton for transport sooDOng to applicable Yilemaliona!and national governmental regulabws It export shipment end I am the Primary <br /> Exporter,I certgy that the contents of Intl ooneignmenl conform to Ste tam of the attached EPAAdetovdedgment of Consent. <br /> I certify that the waste minknlzation statement Identified In 40 CFR 262.27(,)(ti I am a large quantity generator)cr(b)(lr I ofp a smog quan9ly genorelor)is true. <br /> I Ohmes le y Name to ay Year J 0 ll,� <br /> J malbnal Shipments �I <br /> F L.J Importto U.S. El Export m US. Pal of entrylaxfL --- <br /> X <br /> Trampowlat sl nature(for its only): Dale leaving U.S.: <br /> 17,TransporterAckrwvAedgmenl of Rec*of Maledels I <br /> WnU,, Day Year <br /> 64-R&,# A,�-V�� 110 1 Z91 13 <br /> cher 2 Pdntad/fyped Name noturo m y ear <br /> 18.Discrepancy I�I <br /> tBa.Discrepancy indl®tlon Space ❑Quentry, ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manffest Reference Number. <br /> 18b.Alternate Faclf ty(or GarrOMI.or) U.S.EPA ID Number <br /> U <br /> FadPhone: <br /> 18c.Signature of Ale to Facility(or Generator) Month Day Year <br /> Q <br /> 19.Hazardous Waste Report Management Method Codes(Le.,codes for hazardous waste truatmenl,disposal,and recycling systems) <br /> 0 1 2. 3. 4, <br /> 20.Designated Facility Owner or Operate:Cofficallon of receipt of hazardous materials covered by the mentlest except es noted In Item 18a <br /> S' Month Day Y <br /> ypotl Name ear <br /> (� D <br /> EPA Form 8700-22(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO INATION STATE(IF REQUIRED) <br /> ' ,003NAV� <br /> 9140150 <br />