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: � . <br /> Please print or type. Form Approved. OMB No. 2050-0039 <br /> UNIFORM HAZARDOUS 1 . Generator ID Number ml=2. Page 1 of 3. Emergency Response Phone 4. Ma Hest Trackin Number ^ <br /> �. <br /> WASTE MANIFEST C Y. 0 0 0 4 8 0 4 7 1 ( 925 ) 785 -2000 6J7 4 8 FLEtttt <br /> . <br /> 5. Generators Name and Mailing Address Generators Site Address (if different than mailing address) <br /> AMRIT 3ANDHU CAG8SOLINE INC DBA CAGASOLINE EXPRESS <br /> 2115 WEST Y03EMITE AVE 211 W . Yosemite Ave . <br /> MANTECA, CA 95337 Mantaca , CA 95337 <br /> Generator's-Phone: 925 785 - 2000 <br /> 6. Transporter 1 Company Name U.S. EPA ID Number <br /> BELSHIRE CAR O Q 018 3 9 13 <br /> 7. Transporter 2 Company Name U.S. EPAID Number ` " <br /> 8. DWig-nMTi c lffyNg10"e and SffeAddiess - <br /> U . S . ECology , Nevada Operations NV 's 3 3 0 010 0 0 0 <br /> Highway 95 , 11 miles S . of Beatty <br /> B at�o , NV 09003 ( 775 ) 553 - 2203 <br /> get 9b. U.S. DOT Description (induding Proper Shipping Name, Hazard Class, ID Number, 10. Containers 1f . Total 12. Unit 13. Waste Codes <br /> HM and Packing Group (if any)) No. Type Quantity WLNol. <br /> 1' Non^RCRA Hazardous Waste , Solid ( ERG $ 171 ) P 352 * DOI8 <br /> o ( Rags , absorbent , & debris impacted with <br /> petroleum hydrocarbons ) <br /> W 2. r <br /> C9 <br /> 3. <br /> 4. <br /> NEEMENOWN <br /> 14. Special Handling instructions and Additional Information PLEASE WAR ALL � <br /> Generator is a RCRA VSQG as defined in APPROPRIATE PERSMM BESI . 333828 <br /> 40 CPR 260 . 10 . D010 code represents PROTECTM EQUIPIKIMT <br /> waste that is RCRA identified but not <br /> RCRA regulated . PROFIJ,E 0070214257 - 0 J X 5S <br /> 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, <br /> marked and labeled/placarded, and are in all respects in proper condition for transport according to applicable Intematbnaland national governmental regulations. If export shipment and t am the Primary _ <br /> " Witer IF6 rtifylh l fi conten s of tfus eoasknmen't oonform to tie terms of the attaehed'EPAAcknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a) (H I am a large quantity generator) or (b) (if am a small quantity generator) is true. <br /> GeneratoeslOterors PdnWWyped Name } Signature ( " �� Month Day Year <br /> 16. International Shipments <br /> F` ❑ Import to U.S. ❑ Expor► from U.S. Port of entry/exit <br /> ? Transporter signature (for exports only): Date leaving U.S.: <br /> a 17. TransporterAduawledgmenlofReceipt ofMaterials <br /> L, Transporter1 Printedfl Name Signature Month Day Year <br /> a ct•c c 1 1 �o 1. �Q� �-. Z <br /> Transporter 2 PrintediTyped Name Signature Month Day Year <br /> 18. Discrepancy <br /> 18a. Discrepancy Indication Space quantity ❑ Type ❑ Residue ❑ Partial Rejection ❑ Full Rejection <br /> Manifest Reference Number. <br /> 18b. Alternate Facility (or Generator) U.S. EPA ID Number <br /> !t.',1 <br /> L Fadrys Phone: <br /> W 18e. Signature otAltemale Facility (or Generator) Month Day Year <br /> a <br /> z <br /> g iazaWou&Was"epoitManagemantMetwd Codas Q N codes for hazardous waste beaimen4 disposal,-emd-moyding systems)VY <br /> - <br /> G 1 . � 2. 3. 4. • <br /> 20. Destg ted acI ity Owner o Operator. Certification of receipt of hazardous materials covered by the manifest except as nded lryffern 1 <br /> Printedrryped Name Signature Z DW <br /> EPA Form 8700.22 (Rev.t7A) Previous editions are obsolete. DESIGNATED FACILITYTO GENERATOR <br />