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F r ved.OMB No.20 <br /> Please pent or type. Form App o 50-0039 <br /> UNIFORM HAZARDOUS1.Generator ID Number 2,Page 1 of 1 3.Emergency Respo xe Phone d.Manifest Tracking Number <br /> WASTE MANIFEST CAL000429774 1 (877) 577-2669 013120138 F L E <br /> 5.Generator's Name and Mailing Address Httn: 1 e a e y Manager Generator's Site Address(d different than mailing address) <br /> Amazon.com Services, Inc. MCK1) Amazon.com Services, Inc. (DCK1) <br /> (209) 205-0080 2403 West Louise Avenue 2403 West Louise Avenue <br /> Generators Phone: Manteca CA 95337 Manteca, CA 95337 <br /> 6.Tran spWer i Company Name U.S.EPA ID Number <br /> Steric cle Specialty Waste Solutions Inc IMNSOOOII0924 <br /> 7.Transporter 2 Com ny(Nama U.Sf P ID Number <br /> B.Designated FaciGly Name and Site Address Y U m a y e S U.S.EPA ID Number <br /> 2730 E. 13th Street <br /> Yuma, AZ 85365 <br /> Facility's Prone:9286428936 IAZR000515924 <br /> 9a. 9b.U.S.DOT Description(inchr ng Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> 13.YYaste Codas <br /> Ht,1 and Packing Group(d any')) No. Type Duantiy, wwoi. <br /> Non—RUHR Hazardous Waste, Liquid (Latex Paint, 3 DF 00503 331 <br /> o Soap), <br /> z 2. <br /> LU <br /> 3 <br /> 4. <br /> 14.Special HtarAlq irrstrucUons and Aciditiatal informabon o o s e ac o n— e g u atea waste) <br /> S I (. <br /> 15. GENERATDR'SIOFFEROR'S CERTIFICATION: t hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classfied,packaged, <br /> marked and labelediplacarded,and are in all respects in proper condition for transport according to applicable international and national govemmarM regulations.H export shipment and I am the Primary <br /> Exporter,I certify that the contents of Ctrs consignment conform to the terms of the attached EPAAcknoVedgment of Consent <br /> I cerbly that the waste minimization statement identified In 40 CFR 26227(a)(n l am a large quanfity generator)or(b)IRI am a small quantity gcnorator) <br /> Genera qrors PnnWdrf)Rod Name Sgnawre Abnth Day Year <br /> 08 07 PO19 <br /> 16.1n l Stuprtrents 11 import to U.S. <br /> ❑Ecport from U.S. Port of entrylexil <br /> Transporter signature(for exports only): Date leaving U.S.: <br /> x 17.Transporter AckroMadgment of Receipt of Materials <br /> LLJ <br /> Transporter t Printed/Typed Name Sgnature Month Day Year <br /> a Isidro Martinez � 08 07 019 <br /> QTransporter ghalure `, Month Day Year <br /> 18.Dwopancy <br /> 18a.Discrepancy Indication Space ❑ Ot,anby ❑Type ❑Residue ❑Partial Rejection ❑Full Relectbn <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J_ <br /> U <br /> Facility's Phone: <br /> w 18c.Sgnature 0 Alternale Facility(o(Generator) Month Day Year <br /> Q <br /> Z <br /> rn <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous wasto beatment,disposal,and recycling systems) <br /> 01. 2. 3. 4. <br /> 7 <br /> 20.Designated Facility Owner or Operator.Certifcation of receipt of hazardous materials covered by line manifest except as noted In I 18a <br /> Printed/Typed Name Signaturo Month Day Year <br /> EPA Form 8700-22(Rev.1 -1 ) vious editions a obso e. D-SIGNATE F ILITY TO EPA's a-MA (FEST SYSTEM <br /> 8700-22 12v3 09275924 q41 011110 7 7A not A7AgrS M Dr%ar1rxr71 0 cnAonr*7 1 0 <br />