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Please print or type. Form 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 A L 0 0 0 0 4 3 3 3 8 1 (800) 424-9300 01277151282 FLE 5.Ge qe ator' Name and M fling Address GGee�erat r s dress 'f ffier t th n mailing dress) Qui top markets, Inc _ ttui� lop ar�re�s, fnc- #120 4567 Enterprise Street 9521 Thornton Rd_ Fremont, CA 94538 Stockton, CA 95209 Generators Phone: (510) 445-2282 6.Transporter 1 Company Name U.S.EPA ID Number 13E LSHIRE CAR 0 0 0 1 8 3 9 1 3 7 T sporter 2 CompanyName — _ U S.EPA ID Number nr , 0( 8.Designated Facility Name and Site Address U.S.EPA ID Number DeMenno Kerdoon a m n a 0 n i 3 3 K t 2000 N. Alameda St. J. Compton, CA 90222 Facility's Phone: (3 10) 537-7100 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. 1- UN1203, Gasoline Mixture, 3, PG II G 124 p X Z 2. W 3. -- 4. 14.Special Handling Instructions and Additional Information WEAR ALL AFFROPRIATE $ESI : 3 0 9 4 91 ERG#: 128 PER30NAL FRWECTIVE Gasoline 8 Water CLOTHINC-_ QUIK3TGF CCtZ: 65923'7 /X5 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)(it I am a small uantity generator)is true. Generator slOfferor's Printed/Typed Name Signatu Month Day Year 16.International Shipments — �A �t -"- LJ Import to U.S. ❑Export from U.S. Port of en it: ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials LU � Transporter 1 Printe d Name n Signature Month Day Year CL Z Trans er 2 mted/Typed Name Signature Month Day Year r— Z 2— t 18. iscrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑Type El Residue Partial Rejection Full Rejection Manifest Reference Number: 18b.Altemate Facility(or Generator) U.S.EPA ID Number J U uQ. Facility's Phone: LU 18c.Signature of Alternate Facility(or Generator) Month Day Year Q Z N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) W 1. 2. 3. 4. 120..Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 1 Printed/Typed Name � Signature Mon '7Day Year emi It-0 ry ©1 Va © ?iZ— EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. OEs) NATEO FACILITY TO EPA's e-MANIFEST SYSTEM