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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 013120001FLE <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: 206-413-4526 <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 /> ya 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit <br /> p (� 9 P PP 9 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.N01. <br /> 1.UN1993,Waste Flammable liquids,n.o.s.(Petroleum Distillates,Alcohol), 3,PG Il, D001 <br /> W ERG#128 1 CF 4 P <br /> 0 214 <br /> z 2. <br /> w <br /> 0 <br /> 3. F_ <br /> 4. <br /> 14.Sppecial Handling Instructions and Additional Information <br /> 1)109741(Waste Flammable Liquid);Line 1: <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 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 /> 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 /> enerato s eros ante yped Name igna ure on ay Year <br /> Diana Lutz Diana Lutz 07 03 2019 <br /> 116.International Shipments Import to U.S ❑Export from U.S. Part of entry/exit: <br /> I-- <br /> z <br /> Transporter signature for exports only): Date leavingU.S.: <br /> Ll 17.Transporter Acknowledgment of Receipt of Materials <br /> Signature Month Day Year <br /> &j Transporter 1 Printed/ryped Name <br /> O Isidro Martinez Issidroidro Martinez 07 03 2019 <br /> CC) <br /> Z Transporter 2 Printed/Typed Name CAI -Signature on ay ear <br /> < Julian Ruta Julian Ruta 07 03 2019 <br /> F <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 /> V <br /> LL Facilitys Phone: <br /> U 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> h19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> C 1 2• 3• 4. <br /> 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 /> Printed/Typed Name Signature Month Day Year <br /> Vanessa St.John I <br /> Vanessa St.John 07 30 2019 <br /> EPA Form 8700-22(Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />