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Please print or type. Form Approved.OMB No.2050-0039 UNIFORM HAZARDOUS 1.Generator ID Number 2.Page 1 of 3.Emergency Response Phone 4.Manifest Tracking Number WASTEMANIFEST c _ 012952984 FLE 5.Generators Name and Mailing AddressAt t n:Site Safety Manager Generator's Site Address(if different than mailing address) Amazon. com Services, Inc. (DCK1) Amazon. com Services, Inc. (DCKI) (209) 205-0080 2403 West Louise Avenue 2403 West Louise Avenue Generators Phone: — 6.Transporter 1 Company Name S. A ID Number 7.Transporter 2 Company Nae �� U.S.EPA ID Number 7 8.Designated Facility Name and Site Address 21 St Century EMN, LLC U.S.EPA ID Number 2095 Newlands Dr. East Fernley, NV 89408 Facility's Phone-7755752760 ga. 91b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes HM and Packing Group(if any)) No. Type Quantity Wt.Nol. WX RO, UN1993, Waste Flammable liquids, n. o. s. 1 DF 00040 P 213 D001 018 a (Petroleum Distillates, Diesel Fuel), 3, PIS IX I (D001) ERG#128 I z 2. w c7 _ 3. I 4. 14.Special Handling Instructions and Additional Information 1. 109739(F 1 a m m a b 1 e Liquid (Bulk) ) 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, marked and labeled/placarded,and are in all respects in proper condition for transport according to applicable international and national governmental regulations.If export shipment and I am the Primary Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. 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 s quanti ator)is true. Generator's/Offerors Printed/Typed N Signature Month Day Year 11�� 1 �•� 07 1 10 b019 16.International Shipment F ❑Import to U.S. ❑Export from U.S. Port of entry/exit: ? Transporter signature(for exports only): Date leaving U.S.: W 17.Transporter Acknowledgment of Receipt of Materials W Transporter 1 Printed/Typed Name Signatures Month Day Year n� Demarco Brodnax 07 10 019 QTransporter 2 Printed/Typed Name Signafwe Month Day Year 18.Discrepancy 18a.Discrepancy Indication Space ❑ Quantity ❑TypeEl j j Residue Partial Rejection Full Rejection Manifest Reference Number: 18b.Alternate Facility(or Generator) U.S.EPA ID Number J U �a Facility's Phone: w - 11 18c.Signature ofAltemate Facility(or Generator) Month Day Year a Z 55 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) G 1. ' 1 2, 3. 4. i 20.Designated Facility Owner or Operator:Certification of receipt of hazardous materials covered by the manifest except as noted in 8a PrintedfTyped Name (111co6 Signature Month Day Year Emnwb EPA Form 8700-22(Rev.12-17) Previous—editions are obsolete. DESIGNAT D FACILITY TO EPA's e•MANIFEST SYSTEM