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Please print or type <br /> Foran Approved.OMB Na.2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Paye 1 of 3.Emergency Response Phone A.Manifest Trackin Number <br /> WASTE MANIFEST CAL000429774 1 (677) 577--266 014010519 FLE <br /> 5 Genaraws Name and Mailing Address At t n:Site Safety Manager Generator's Sale Address(il ditto en!than mailing address) <br /> Amazon. cos Services, Inc. (DCVI) Amazon. com Services, Inc. (DCK1) <br /> (209) 205--0080 2403 West Louise Avenue .'-.4a3 West Louise Avenue <br /> Generalo'sPhone- Manteca, CA 95337 Manteca CA 95337 <br /> [6, ransporter 1 Ccmoany NameU.S.EPA IO Number <br /> Stericvcle S e Solutions Inch1NS000110924 <br /> rarspurl2r2 Company Name U.S.EPA Ip Number <br /> Z <br /> . esignated Facility Name andSite Address Yuma Ye 5, LLC U.S.EPA ID Number <br /> 2730 E. 13th Street <br /> Yuma, AZ 85365 <br /> Faalily's Pture 64PA14aB <br /> 15 �4 <br /> 93 tib.U S.DOT Description(including Proper Shipping Nara,Hazard Class.ID Number. 10 Containers 11.Total 12.Unit <br /> Ht,l and Packing Group(il any)) 19.Waste Gorses <br /> Na. Type QuanLly �vlA'oi. <br /> � Non—RCRA Hazardous Waste, Liquid (Latex Paint, 1 DF 00170 P 3311 <br /> 0 Saap) , -----`-- - -- <br /> w i <br /> ) <br /> z 2. <br /> w <br /> c9 { <br /> 3. ! <br /> i <br /> 1 <br /> t <br /> f <br /> r <br /> 14 SpedalHandling lnstrudicnsand Additional Information 1. 109763(LoosePack Non—Regulated Waste) <br /> X/?Cot-( <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby dodare that the contents of this consignment are fully and accurately described aboie by the proper shipping name,ani are dasslfied,packaged, <br /> marked and labeledtptacarded,and are in all respects in proper condition for transport according to applicable inlemationa;and naLnnal governmental regulations.If export shipment and I am LI-A Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of int;attached EPAAcknowledgment of Consent. <br /> I certify that tho waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(if[am a small quantity gerreralor)is true. <br /> Gene rator's/O3eror's PrintedrTyped Name Signature Monti Day Year <br /> A C Cr )r+ <br /> 16.International Shipments <br /> Z ❑Impart io U.S. ElExport from U.S. Port of enlryfexit_ <br /> Transporter signature(for exports onfy): Dale leaving U.S.. <br /> w <br /> V.Transporter AcknowiedgmentofReceiptotMateyiats <br /> Transporter 1 Printed/Typed Name Signature <br /> O 64prih Day Year <br /> a <br /> Q ra er 2 Printed(Typed Name 11 of; �Olql <br /> S gna+ o <br /> blench Day Yoar <br /> 16.Discrepancy <br /> 163.Discrepancy Indi-caCron Space <br /> ❑ Quantity ❑Type ❑Residue ❑Par'W Rejection ❑Full Re,pdon <br /> Manifest Reference Nt tuber <br /> 16D.Alternate Facility(or Genctalor) U.S.EPA ID Number <br /> U <br /> Facility's Phone: <br /> w 1Sc.Signature of Alternate Facaity(or Generator) <br /> Q 6bnth Day Year <br /> a <br /> 19.Hazardous Waslo Report t t,4anagemon!Monod Codes(i.e..codes for hazardous waste IroWmen(,dsposa!,and recyang systems) <br /> pLj4. <br /> 20,Designaled FacilityDa or cr Operator Ceritication of receipt of hazardous materials veered by t~a manifest except noted n Item 18a <br /> Printe1,rTyped Name Signature Month Day Year <br /> II c� <br /> EPA Form 8700-22(Rev.1 -17) Previoljs editions re obsolete. WDE'iGoTED FACILITY TO EPA's e-MANIFEST SYSTE.ftr <br />