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Please print or type, 11111111101010 Form Approved. <br /> 1Generator ID Number be ed.0118 No.2050 0039 <br /> . <br /> UNIFORM HAZARDOUS 2.Page t of 3.EmergeruyResponse Ptwne 4.ManlfestTracking Number <br /> WASTE MANIFEST CAL000429774 1 U377) 577-2669 013119958 F L E <br /> 5.Generatofs Name and Maiing Address At t n S S i t e Safety Manager Generators Site Address(if different then marling address) <br /> Amazon.com Services, Inc. (DCK1) Amazon.com Services, Inc, (DCK1) <br /> 2092050080 2403 West Louise Avenue 2403 West Louise Avenue <br /> C-ereratofs Phone: <br /> 6.Transporter 1 Company Name U. .EPA(D Number <br /> 7.Traruporter 2 Compo ry Nama U.S.EPA Oft <br /> B.Designated Facility llama and Site Address Yuma Yes, LLC U.S.EPA 10 Number <br /> 2730 E. 13th Street <br /> Yuma, AZ 85365 <br /> 6!',sphone: <br /> 93, 9b.U.S.DOT Description(utdudng Proper Shipping Name,Hazard Class,ID Number. 10.Containers 11.Total 12 Unit <br /> HM and Packing Group(ifany)) No. Type Quantity Wtml. 13.Waste Codes <br /> o ' Non—RCRA Hazardous Waste, Liquid (Latex Paint, 1 DF 00155 P 33 <br /> Soap), <br /> w <br /> Z 2. <br /> w <br /> 3. <br /> 4. <br /> 14.Special Handling lnshrudonsand Add6onalInformation 1. 109763(Loo5ePack Non—Regulated Waste) <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION:I hereby declare that the contents of this consignment are fulty and accurately described above Dy the proper slipping name,and am Bass`ed packaged <br /> marked and labeled/placarded,and are in al respects in proper condition for transport acrbtd ng to applicable intemationaland naffonal governmental regulatrons.If export sh!pmenl and I am the Primary <br /> Exporter,I certify that the contents of this eonsignmeni conform to the terms of the attached EPAAcbowiedgment of Corsent <br /> I cert ly that the waste minimizaL•on statement identited in 40 CFR 262.27(a)(41 am a large quAty generator)or(b)pf am a small quantity generator)Is true. <br /> Generatoes106 oris P'ledlT"Name 1 Sgrature + month Day Year <br /> MD <br /> I Ord PAI P01:1 <br /> 8.ince Donal hipmeats 0 Icy to U.S. <br /> ❑Export tram U.S. Port of entrytexit: <br /> Transporter signature(for exports only): Dale leav(ng U.S.: <br /> w 17.Transporter Adnowiedgment of Receipt of Materials <br /> Transporter t PrurtedlTyped Name <br /> O MoM.h - Day Year <br /> a <br /> ZTrans er 2 Prinled/T Name a Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑TYDo ❑Reside Partial Rejection ection ❑Fu3Ro*Wn <br /> 18b.Altema:e Facility(or Generator) Mar�tesI Reference Number. <br /> U.S.EPA 10 Number <br /> J <br /> U <br /> LL Facility's Phone: <br /> W 18c Signature of Alternate FadOty(or Generator) <br /> Q Month Day Year <br /> w19.Hazardous Waste Report Management Method Codes(i.e..codes for hazardous waste treatment,disposal,and(ecydrg systems) <br /> ca 1 2. 3. <br /> 4. <br /> 20.Designated Fad',,j Owner or Operator.Certlficallon of receipt of hazardous materials covered by ft manifest except as rot in Item 18a <br /> Printed7Typed Name Signature Month Day Year <br /> 1M11'. �_AIIYMAP), I - A w ,I, I -::Ll t 1 [q . <br /> EPA Fcrm 8700.22(Rev.12-17) Previouslho <br /> a ns are obsolete. 4 <br /> (.)LS(GP.AT- FACILITY TO EPA's e•fYIANIFEST SYSTEM <br />