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' Jlale or l.alttornW—environmental rrotwhon Agency <br /> Form,Approved OMB No.2056-0039(Expirsi 9-30-99 See Instructions on back of pope v. Department of Toxic Substances Control <br /> Sacramento,California <br /> Please print or type. form designed for use on efite f 12 pitch)typewriter. <br /> UNIFORM HAZARDOUS 1. Generator's US EPA ID No. ManiFest Document No. 2. Page 1 Informal on in the shaded grecs <br /> - is not required by Federal law. <br /> WASTE MANIFEST G A101913111416.113 '1815 1 0 6 3 2 � °f es <br /> 3. Generator's Name ono.Mailing Address A. Stale Manifest Document Number <br /> %� 1.7 <br /> 7--Eleven Inc. P.D. Box 80741 `f '' 3 3 8 5- <br /> 0 Rancho Sante Margarita, CA 92668 B. State Generator's ID <br /> h <br /> 4. Generator's Phone 194 f 460' ?-W !. <br /> N 5. Transporter?Company Nome b. US EPA ID Number C. State Transporter's ID(Reserved.] <br /> in <br /> CP <br /> D. Transporter's Phone <br /> 0 88t,sHTRE EHVIRONNE AL SVCS. A D 9 8 `i $ 4 5 8 1 <br /> 00 7. Transporter 2 Company Name 8. US EPA ID Number E. Stole Transporter's ID(Rasarved.j <br /> .1 <br /> S ";,— ?'�O F. Transporter's Phane <br /> 70 9. Desi noted Facili Nome and Site Addr s 10. US EPA 1D Number G. State Facility's ID j <br /> U.�. Eca ogy, Nevada Operations <br /> 0 Highway 95, 12 NilesS.of Beatty H. Facility's Phone <br /> nez Realty, N9 A9003 V T 3 3 8 S 1 �! alai* 775-353-22@3 I <br /> -,j=i =Qwrtfit�y <br /> 14. Unit <br /> V11. US DOT Description(including Proper Slipping Name,Hazard Class,and ID Number) Wt/Vol I. Waste Number <br /> z State ,152 <br /> Sol.lds Contains _ ;r3a-aimable- t..iquid, n.C.0. <br /> 4. 1 UN3175 P.O. I1 d' EPA <br /> 3 G I <br /> E b. State <br /> coEPA/0`16r <br /> v R <br /> state <br /> A' <br /> v A' �. <br /> 0 p EPA�b er f <br /> CieR 9 State <br /> LU d. - <br /> Z EPA/Ofher <br /> ts.t <br /> V <br /> wKHandling Codes for Wastes Listed Above <br /> 'n J. Addilional Descriptions for Mcleriols Us K.Above <br /> Z a. _ 6• <br /> 0 <br /> 10133 d. <br /> Q <br /> Z 15. Special Handling Instrucfions and Addi•anal Information <br /> O <br /> Debris wikh gasal3�, 24 HOUR CY PHf A L 111884 SITE:7- 1ev u i:l:� <br /> Z WEAR ALL QPPR[1F€�IA 349-450-5200 (5-7 gas-spm) 4327' Da Vinci Or ve <br /> PROTECTIVE CLOTHING <br /> 9'49--699.-3706 (24-hours) Stockton, CA 95207' <br /> 4 s of this consignment are Fully and accurately described above by proper shipping name and are classified,packe <br /> 16. GENERATOR'S CERTIFICATION: l hereby declare that the contentd, j <br /> < marked,and labeled,and are in all respects in proper condition For transport by highway according to applicable international and nations!government regulations. <br /> If I am a large quantity generator,I certify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economically <br /> CL practicable and that I have selected the practicable method of treatment,storage,or disposal currently of y w st me which minimizes the present and future threat to human health <br /> and the environment;OR,if I am•p s all quantity generator,I have mode a good Faith effort to iz my waste generation and select the best waste management method that is <br /> cc available to me and that I can afford. <br /> O Month Day <br /> Printed/Typed Name Signature Year . <br /> z Larry Hoothart REST or Generator l' `' ✓ ` r- <br /> w T 17. Transporter l Acknowled &in t f R ei t of Materials �i ✓s <br /> MontDay <br /> h <br /> a[ A Printed /Typed No' y SignaloreLU <br /> LU 5 �.-v <br /> w 0 18. Transporter Acknowled anion,of Re ei t of <br /> Materialsr ..._._.• Month ^ Day r <br /> 0RT jgSinaue <br /> PrWed/Typed Nomq <br /> \`. <br /> / R- <br /> U 19. Discrlponcy Indication Space <br /> Z F <br /> A <br /> C <br /> I <br /> 20. Facility Owner or stator Certificafi n of races t of hazardous materials covered by this manifest except as noted in Item 19. Month Day Year <br /> T Printed/Typed Nome Signature <br /> r ) <br /> t <br /> DO NOT WRI BELOW HW CINE. <br /> FAC, �, Yellow: TSDF SENDS THIS COPY TO GENERATOR WITHIN 30 DAYS. <br /> (Generators who submit hazardous woste far transport ovt-cf-slote. <br /> DT50022A Lla9bn— produce completed copy of this copy and send to DTSC within 30 days.( <br /> EPA 8700-22 <br />