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Please pa1111111HUINIIIInt or type. Fonn Approved.OfA6 No.2050-0039 <br /> UNIFORM HAZARDOUS 1,Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number <br /> YYASTEMANIFEST CAL000429774 1 1 (877) 577-2669 013648824 FLE <br /> 5.Gertmator's Namo and Mailing Address At t n;71 e Sa f e t y t-1an a g e r Generators Site Address(i different than mailing address) <br /> Amazon. com Services, Inc. (DCKi> Awazon. com Services, Inc. (DCK1) <br /> (209) 205-0080 2403 West Louise Avenue 2403 West Louise Avenue <br /> Gereralor'sPione Manteca, CA 95337 Manteca, CA 95337 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Stericycle Specialty Waste Solutions Inc MNS0001109E4 <br /> 7.Trarsponer2 Company Namg U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address Y U M a Yes, L L G, U S.EPA ID Number <br /> 2730 E. 13th Street <br /> Yuma, AZ 85365 <br /> Faclay's Pnone:92564289:38 AZ R000515924 <br /> ger 9b.U-S.DOT Description(irk;uding Proper Shipping Name.Hazard Class.ID Number, 10.Containers 11.Total 12,Unit <br /> Hl and Packing Group(i1 any)) No Type Quantity WtNol, 13.vlaste Godes <br /> Non-RCRA Hazardous Waste, Liquid (Latex Paint, 3 DF 00397 P 331 <br /> o Soap) , <br /> d <br /> z 2. <br /> w <br /> 3. <br /> 4. <br /> I <br /> 14.Special HandlingInstructions and Additionalfnformalion 1. 109763(LoosePack Non-Regulated Waste) <br /> 15. GEN ERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this conslgnmont are fuliy and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeledlptacarded,and are in all respects in proper condition for transport according to applicable intematiordand national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment contort to ft terms of the attached EPAAcknowiadgment of Consent. <br /> I certify that the waste minimization statement identified In 40 CFR 262.27(a)(if I am a large quantity generator)or(b)(dl am a small quantity generator)is true. <br /> orsiCtioror's Pr nledlTyped Name J,.re �n ^ Month Day Year <br /> op- 201 r <br /> _j6.Inlemalional Shipntenls <br /> ❑Import to U.S. ❑Export from &S. Pont of ontrylept: <br /> z Transporter signature(for oxports only): Date leavirg U.S.: <br /> Ix 17.TransporterAdinormedgment of Roceipt of Materials <br /> Transporter 1 PrinledlTyped Name Signatu Month Day Year <br /> 4 Jesus A Marquez Drtega - 11 02 IF01, <br /> z Trans r 2 Printed,Typed Name S gna Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type Residua Partial Rejection ❑Fulf Rejection <br /> Maritfesi Reference Number. <br /> 18b.Alternate Facility(a Gersrala) U.S.EPA ID Number <br /> U <br /> u- Facilites Phone: <br /> S 18c.Signature of Altemale Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> 19.Hazardous Waste Report Maragement Method Codes(-e.,codes for hazardous waste treatment,disposal,and recyUurg systems) <br /> Lu t. 2. 3. 4. <br /> :jP�/ <br /> I20.Designated Fadl ty O+rner or 6peratDr.Certificat on of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> I Prt.�,toA t 74)0 " I ( 111 11.1 I /q , <br /> Prin!edrTyped Name Signature Month Day Year <br /> EPA Form 8700-22(Rev.11-17) Pr vious editions are o solete. D=SIGN Jo FACILITY TO EPA's e-t0ANAST SYSTEM <br /> 8700-22-12Y3 08275924 541080778 0415'/7384 11 PD 110219 SDi10219 <br />