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111111111111111 Form Approved.OMB No.2050-0039 <br /> Please print or type. <br /> UNIFORM HAZARDOUS 1.Generator ID Number Tj-fT3Page 1 o .Emergency Response Phone 4.Mani013120001 <br /> fesr�r� Oro o F L E <br /> WASTE MANIFEST CAL000429774 (877) 577-2669 <br /> 5.Generators Name and Mailing Address f1ttlIsSite B.If ty MandgGenerators Site Address(if different than mailing address) <br /> Amazon.com Services, Inc. (DCK1) Amazon.com Services, Inc. (DCKI) <br /> (209) 205-0080 2403 West Louise Avenue 2403 West Louise Avenue <br /> Generators Phone: Manteca CA 95337 Manteca CA 95337 <br /> U.S.EPA ID Number <br /> 6.Transporter 1 Company Name <br /> Steric cle Specialty Waste Solutions Inc MNS000110924 <br /> U.S.EPA ID Number <br /> 7.Transporter 2 Company Name <br /> _ T n y <br /> 8.Designated Facility Name and Site Address 21st Century EMN, LLC U.S.EPA ID Number <br /> 2095 Newlands Dr. East <br /> Fernley, NV 89408 <br /> Facility's Phone:7755752760 NVD9B0895338 <br /> 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers FTotalwt Unit13.Waste Codes <br /> 9a. Wt.Nol.HM and Packing Group(if any)) No. TypeX UN1993, Waste Flammable liquids, n. o. s. 1 CF P 2141DO01 <br /> o (Petroleum Distillates, Alcohol), 3, PG II, <br /> 9 ERG#128 <br /> LU 2. <br /> LU <br /> c7 <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additional Information 1. 109741 (Waste Flammable Liquid) <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 transport according to applicable intemational 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 EPA Acknowledgment 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 smal ntity ge eralor is true. Month Day Year <br /> Generators/Offerors Printerryped Name signal ` <br /> ` U�—Z- , 071 03 201 <br /> 16.international Shipments ❑Import to U.S. ❑Export from U.S. Port of entrylexit: <br /> Date leaving U.S.: <br /> ? Transporter signature(for exports only): <br /> W 17.Transporter Acknowledgment of Receipt of Materials Month Day Year <br /> Uj Uj Transporter 1 Printed Typed Name Signature <br /> 07 03 201 <br /> a Isidro Martinez Month Day Year <br /> Z Transporter 2 Printedlfyped Name Signature <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication SpaceQuantity El Type ❑Residue ❑Partial Rejection El Full Rejection <br /> ❑ <br /> Manifest Reference Number. <br /> U.S.EPA ID Number <br /> � 18b.Alternate Facility(or Generator) <br /> J <br /> U <br /> Facility's Phone: Month Day Year <br /> W 18c.Signature of Alternate Facility(or Generator) <br /> a <br /> Z <br /> N 19.Hazardous Wa <br /> ste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 4 <br /> 0 3acili i or 0 erator:Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a <br /> ty P Signatu Month Day Year <br /> me ~0 <br /> LL� <br /> EPA Form 5700 22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY Td EPA's e MANIFEST SYST M <br />