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Please print or type. IIullI <br /> FGeneratoes <br /> ZARDOUS 1.Generator ID Number Form Approved.OMB No.2050-0( <br /> 2.Page 1 of 3.Emergency Response Phone 4.Manliest Tracking Number <br /> NIFEST CAL000429774 1 (877) 577-2669 01-3120192 F L E <br /> me and Mailing Address r. G (ors Site Address(if different than mailing address) <br /> AmaZOn.com Services, Inc. (DCN1) Amazon. com Services, Inc. (DCK1) <br /> 05-0080 2403 West Louise Avenue 2403 West Louise Avenue <br /> Generators Phone: Manteca, CA 95337Manteca, CA <br /> 6.Transporter 1 Company Name 95337 <br /> Stericycle Specialty Waste Solutions Inc U.S.EPA ID Number <br /> .Transporter 2 Company Name MNS00 Ln 110924 <br /> 7 <br /> U.S.EPA ID Number <br /> 8.Designated Facility Name and Site Address Gene ra 1 Environmental Mgt, LLC U.S.EPA ID Number <br /> 11855 White Rock Road <br /> Rancho Cordova, CA 95742 <br /> I <br /> Facility's Phone:9163510980 CAD980884183 <br /> ga, 9b.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 /> X �JNI950, Waste Aerosols, [flammable, (each not 1 CF <br /> a exceeding 1 L capacity)] 2. 1, ERG#126 00007 p 331 D001 <br /> LU <br /> Z 2. <br /> r <br /> 3. 1 <br /> I <br /> 4. <br /> 14.Special Handling Instructions and Additional Information 1. 109718(Flammable Aerosols) <br /> 15. GENERATOR'S/OFFEROR'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 transport according to applicable internalionaland 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)lift am a small quantity generator)is true. <br /> Generators/Offerors Printe.typed Name <br /> Signature Month Day Year <br /> A �r eGl .gip �q�py <br /> .j 16.International Shipments v' �r �,.0 �8 14 EQt i 9 <br /> Z <br /> 11 Import to U.S. ❑ <br /> Transporter signature(for exports only) Export from U.S. Port of entrylexit:: <br /> = 17.Transporter Acknowledgment of Receipt of Materials Date leaving U.S.: <br /> w <br /> Transporter 1 Printed/Typed Name <br /> COL <br /> Signature Month Day Year <br /> � Isidro Martinez <br /> Zz Transporter 2 Print_,yped Name 08 14 01 <br /> t- <br /> Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space <br /> ❑ Quantity ❑Type <br /> ❑Residue ❑Partial Rejection ❑Full Rejection <br /> 18b.Alternate Facility(or Generator) Manifest Reference Number: <br /> J U.S.EPA ID Number <br /> U <br /> u- Facility's Phone: <br /> w 18c.Signature of Allemate Facility(or Generator) <br /> Q <br /> z Month Day Year <br /> co 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardo <br /> � 1. us waste treatment,disposal,and recycling systems) <br /> 2. 3. <br /> 4. <br /> 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in It <br /> Printed/Typed Name <br /> Y Signature <br /> Month Day Ye <br /> EPA Farm 8700-22(Rev.12-17) evious editions,re obsODL-. 61 <br /> 1, <br />