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State of Cohlorric—Environmental Protection Agency <br /> Form Approved OMB No 2050-0039(Expires 9 30 99; See Instructions on back of page 6 / Department of Tax=c Substances Control <br /> Pleafe pr nt or type Form designed for use an elite 02 pitch)typewriter 4 Sacramento California <br /> UNIFORM HAZARDOUS I Generators US EPA 10 No Manifest Document No 2 Page 1 Information in the shaded areas <br /> is net required by Federal low <br /> WASTE MANIFEST C AIL_1010101�151jjq 1101,31 111118 8 e 1 of 1 <br /> 3 Generators Name and Marling Address A State Manifest Document Number <br /> 7-Eleven Inc. 10220 S.N. Greenburg Road 23543513 <br /> I Suite 478 Portland Oregon 97223 B Siote Generator 1 FD <br /> A Genaralor s Phone111 1111 ] jj III <br /> 253 M-7170 <br /> (j 5 Transporter i Company Name 6 US EPA ID Number $tple Tronsporters ID(R"Mid) <br /> to <br /> ap' o BELSHIItfi EIIVI$OHIi®TAL SVCS. CAD 9 8 3 5 $ 4 6 8 1 D Tran,parter•.Pf�r,. 049-4:18-1818 <br /> 0 <br /> 00 7 Transporter 2 Company Name 8 US EPA 1D Number E Stats Ttangorters ID K.Lgnd I <br /> C.� F Tsal+sportar's Phoms <br /> C1 9 si�ggrh� te Address 10 US EPA ID Number Gktlq Factldl/4 lD <br /> oo13352 <br /> -'r z 2000 H. Alii WMA STREET H r-odirvis Phone <br /> .n O CONMR, CA 90222 CAT 0 8 8 8 1 3 3 5 2 318--537-7180 <br /> 12 Conteirrers 13 Total ld Unit <br /> 11 US DOT Description(mcludmg Proper Shipping Name Hazard Class,and ID Number) No T Quantity Wt/Vol I Waste Number <br /> Z a GASOLINE SIHTl1RE state 134 <br />' 3 G 3 081.203 PG II / 1_PA Other <br /> AS A RCRA WASTE)E <br /> N b 1 sbm <br /> o <br /> co E EPA/Q+or <br />' v R <br /> v A c State _ <br /> W O EPA/01M7 <br /> R <br />' w d qhs <br /> t— <br /> VEPA/011+er �- <br /> w <br /> 1 Addshonal Doscnphons for Materials Usted Above $ K 149tAno Codes For Wastes listed Above <br /> b <br /> $RG #128 t c R d <br /> Q <br />' 0 15 Special Handling Instructions and Additional Information <br /> MROCASBONS AND NATER 24-HOUR ENERMUT PROSE: Q Sid � Q 3 W? 0�- <br /> i NEAR ALL APPROPRIATE 949-456-1010 (N-F Base-5Pt) SITE:'--Eleven # 5aawa- <br /> I <br /> s PROTECTIVE CLOTHING 949-753-582.6 (24-hours) 3LoQ W. ram~ <br /> A4 C <br /> 16 GENERATOR'S CERT1FIeATION I hereby declare that the contents of tha consignment are Fully and accurately described above toy proper sh rpprm n e and are classified packed <br /> Vmarked and labeled,and are in all respects in proper condition For transport by highway according to applrcoble mternahona!!and notional gov meat ragulahoos <br />' J <br /> If I am a largo quantify generator,I arrtify that I Imre a program in place to reduce the volume and toxicity of wastes generated to the degree I have determined to be economically <br /> a practicable and that I have selecled the practicable method of treatment storage or disposal currently available!o ma which minimizes the present and Future Ihraat to human health <br /> and the environment OR,if I am a small quantity generator,I have made a good Faith effort my waste generation and soled the best waste management method that u <br /> Oavailable to me and that I tan afford <br /> noted T oght BESI for 7—Eleven 1+'g:'gnahrra ntfjrti/ Day Year <br />' V [a% <br /> Z <br /> LU p 17 Transporter 1 AchnnovditcIntment of Recoilof M Month D Year <br /> A^ <br /> Printed/T Signature ay <br /> $.0 VW S <br />' O 0 1 B Trans iter cknawl eine of Racal of Materials <br /> K <br /> Prmted/TYped Name Signature Month Day Year <br /> Lili E <br /> Q R <br /> V 19 Discrepancy' Indication <br /> Space Z F <br /> A FAC# 3m Z <br /> — <br /> C <br /> I ID#_ f?612 <br /> f 20 foci sly Owner or—opt for Ceirnheotian of real I of hazardous materials cover m t excs d m Item 39 <br />' Sires Month Day Yaar <br /> T �snt�/TYPed Nam <br /> Y Q <br /> DO NOT WRITE BELOW THIS LINE <br />' white TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS <br /> DTSC 8022A(1/99) To PO Box 3000 Sacramento CA 95812 <br /> EPA 8700--22 <br /> I <br />