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Please orint or tv[)e. (Form.desinned for use on elite (1 2 -[)itch) tvoewhter.) Form Approved. OMB No. 2050-0039 EPA Form 8700-22 (Rev. 3-05/ Plkviou it ns are obsolete. 11920.0995 UtSIGNAYCU I-Al�trY—Fid U I INA11UR SIAI t IlrAC6i!IT J) IT DI TO 1 TZAR 'SS( if. mA UNIFORM HAZARDOUS V 1. Generator ID Number 2. Page ]&F!�O 3. Emergency Response Phone 4. Mbfest Number 07640237 FLE WASTE MANIFEST C 000270082 1 424-9 00 5. Generators Name and Mailing Address or s SiteAddress (ii different than mailing address) 7 -Eleven. Inc. 7 -Eleven 14113 P.O. Box 80741 3040 West Benjamin Halt Drive Rancho Santa Margarita, CA 82888 Stockton, CA 95219 Generators Phone: (949) 460-52M 6. Transporter 1 Company Name U.S. EPA ID Number AID. Number j 7. TranVorter 2 Company Name U.S. EPA 8. Designated Fadity Name and Site Address U.S. EPA ID Number DeMenno Kerdoon CAT080013352 2000 N. Alameda St. Pp irrthon, CA 90222 9a 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit 13. Waste Codes No. Type HM and Packing Group (if any)) Quantity WtNol. o X 1. LIN1203, Gasoline Mixture, 3, PG II i G � I M z 2. LU c7 3. 4. / 14. Special Handling Instructions and Additional Infomrabon WEAR ALL APPROPRIATE BES1:247883 F FOLD LABELLINE. AFX . ERO 128 SIDE OFR RI Gasoline &.Water PROTECTIVE CLOTHING 7-11 CCN: 813710 MATERIAL BIU / TAB STICKS 01 LnWr OtiAu 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 condit on for transport according to applicable international and pational 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. 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 qua nerator) is true. Generator sl0fferoes PrintediTyped Name Signature Monln Uay year Lang Moothart of BESI on behalf of generator _J 16. Intemational Shipments ❑ Import to U.S. L1 Export from U.S. Port of entry/exit: Transporter signature for exports only): Date leaving U.S.: rr Li 17. Transporter Acknowledgment of Receipt of Materials Li 2 Transpo 1 Printed/Typed Name nature 1`` �//� on Day Year ` PO\ I `.� •A�� IZ 1 QT%-- 2Transporter 2 Prinled(Typed Name Signature Month, ay Year Ix Ix T L✓ Z 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 Q LL FacilitVs Phone: w 18c. Signature of Alternate Facility (or Generator) Month Day Year a z 19. Hazardous Waste Report Management Method Codes (.e., codes for hazardous waste treatment, disposal, and recycling systems) 1 2. 3. 4. 2W�.'naledl faality Owner or Operator. Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year EPA Form 8700-22 (Rev. 3-05/ Plkviou it ns are obsolete. 11920.0995 UtSIGNAYCU I-Al�trY—Fid U I INA11UR SIAI t IlrAC6i!IT J) IT DI TO 1 TZAR 'SS( if. mA