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Please print or type. 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 CAR000298380 1 877-577-2669 013120137FLE <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> AMAZON.COM SERVICES,LLC DCK1 2403 WEST LOUISE AVE <br /> P.O BOX 80842 MANTECA CA,95337 <br /> SEATTLE WA,98108 <br /> Generator's Phone: 2 6-41 -4 2 <br /> 6.Transporter 1 company ame U.S.EPA ID Number <br /> Stericycle Specialty Waste Solutions Inc MNS000110924 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> Stericycle Specialty Waste Solutions Inc MNS000110924 <br /> 8.Designated Facility Name and Site Address U.S.EPA ID Number <br /> 21st Century Environmental Management of Nevada,LLC NVD980895338 <br /> 2095 Newlands Drive East <br /> Fernley NV,89408 <br /> Facility's Phone: 775-575-2760 <br /> 9a. 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> 1.UN1993,Waste Flammable liquids,n.o.s.(Petroleum Distillates,Alcohol), 3,PG II, D001 <br /> p ERG#128 1 CF 36 P <br /> 214 <br /> zUN2811,Waste Toxic solids,organic,n.o.s.(2,4-D,Silver), 6.1,PG 11,(D011), <br /> W ERG#154 D005 0006 D008 <br /> 0 1 CF 3 P <br /> D016 331 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information <br /> 1)109741(Waste Flammable Liquid)2)109796(Toxic Loosepack-Solids Only-No Fertilizers);Line 1:Line 2: <br /> 15. GENERATOR'SIOFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition for transpod according to applicable international and national governmental regulations.If export shipment and I am the Primary <br /> Exporter,I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment 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)(if I am a small quantity generator)is true. <br /> eneralo s eros Printed/Typed NamePrinted/Type Signature Month Day Year <br /> Shara Davis Shara Davis 08 07 2019 <br /> .j 16.International Shipments <br /> Import to U.S ❑Export from U.S. Port of entry/exit: <br /> Z Transporter signature for exports only): Date leaving U.S.: <br /> LU 17.TransporterAcknowledgment of Receipt of Materials <br /> Transporter 1 Printedrryped Name Signature Month Day Year <br /> COIsidro Martinez Isidro Martinez <br /> . ro 08 07 2019 <br /> Z Transporter 2 Printedrryped Name Signature month Day Year <br /> Q <br /> Julian Ruta Julian Ruta 08 07 2019 <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑Quantity [--]Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> Manifest Reference Number: <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> J <br /> U <br /> Facilitys Phone: <br /> W 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> a <br /> Z <br /> 05 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G <br /> H141 H141 <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> Printedrryped Name Signature Month Day Year <br /> Alma Luoto Alma Luoto 08 26 2019 <br /> EPA Form 8700-22(Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />