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Please print or type. <br /> Form Approved.OMB No,2050-0039 <br /> UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> WASTE MANIFEST CALL100429774 1 (877) 577-2669 F L E <br /> 5.Generators Name and Mailing Address At t i i:Site Sa r e t y )'lan a+g e Y Generator's Site Address(if different than mailing address) <br /> Atllazon. colo Services, Inc. (DICK 1) Amazon. cola Services, Inc, (DC}(i) <br /> (2013) 2-10.5-0060 2403 West, Louise Avenue 2403 West Louise Avenue <br /> Generator'sPnone: r'l tnt-eca, CA '35337 trfanteca, CA 95337 <br /> 6 Transpo ter 1 Company Name U.S.EPA ID Number <br /> Stericycle Specialty Waste Solutions Inc PINS000110924 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> '4orldwide Recovery Systems CARO 01754L2 <br /> 8.Designated Faclify Name and Sile Address Y u Ma Yes, LLC U.S.EPA ID Number <br /> 2730 E. 13th Street <br /> Yuma, AZ 85365 <br /> Facility's Phone: 9236428938 AZ R000515924 <br /> ga. 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers <br /> HM and Packing Group(if any)) 11.Total 12.Unit 13.Waste Codes <br /> No. Type Quantity Wt.Nol. <br /> 'Non-RCRA Hazardous Wa5te, Liquid (Latex Paint, 1 DF 00177 P <br /> 331 <br /> Soap) , - <br /> Z 2 <br /> LU <br /> (7 <br /> 3. <br /> 4, <br /> 14.Special Handling Instructions and Additional Information 1. 109763(LuosePack Non-Regulated Waste) <br /> 15. GENERATOR'S/OFFEROR's CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the pro ipping name, are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable inlemationaland national governmental re proper <br /> If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the loans of the attached EPA Acknowledgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if I am a large quantity generator)¢r(b)(if I am a small quantity generator)is Wk. <br /> Generator'_s/Offeror's PrintedrTyped NameSignature Month Day Year <br /> 271201r- <br /> -j 16.International Shipments <br /> Z ❑Import to U.S. ❑Export from U.S. Port of entry/exit: <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> 17.Transporter Acknowledgment of Receipt of Materials <br /> w <br /> 0 Transporter 1 PriniedlTyped Name SignaI Month Day Year <br /> Q. Isidro Martinez <br /> a Transp r 2 PrinleVyped aV r 11 `Y 201_ <br /> Month Da Year <br /> (— C <br /> , / <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> 181b.Alternate Facility(or Generator) Manifest Reference Number: <br /> J <br /> U.S.EPA ID Number <br /> U <br /> u– Facility's Phone: <br /> w 18c.Signature of Altemate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> w <br /> 3 4. <br /> 6 <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Prinled/Typed Nam – Signature <br /> Month Day Year <br /> mual <br /> U u t <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNqCqjILITY TO EPA's e-MANIFEST SYSTEM <br />