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Please print or type. Form Approved.OMB No.2050-0039 <br /> 1.Generator ID Number <br /> UNIFORM HAZARDOUS 2.Page 1 of 3.Emergency Response Phone 4.Manifest rac 'n N <br /> WASTE MANIFEST CAL000429774 1 (877) 577-2669 01-2§9 983 FLE <br /> 5.Generators Name and Mailing AddressAt t n:S i t e Safety Manager Generator's Site Address(if different than mailing address) <br /> Amazon.com Services, Inc. (DCK1) Amazon.com Services, Inc. (DCK1) <br /> (209) 205-0080 2403 West Louise Avenue 2403 West Louise Avenue <br /> Generator's Phone: Manteca, CA 95337 Manteca CA 95337 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Steric cle Specialty Waste Solutions Inc IMNS000110924 <br /> 17.Trans o ler 2 Company Name U.S.EPA ID Number <br /> & L, <br /> Designated Facility Name and a Address Rho Chem, LLC ' U.S.EPA ID Number <br /> 425 Isis Avenue <br /> Inglewood, CA 90301 <br /> Facility's Phone. <br /> 0 <br /> ga, 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 1i.Total 12.Unit <br /> HM and Packing Group(if any)) 13.Waste Codes <br /> No. Type Quantity Wt vol. <br /> w X M2, UN3267, Waste .Corrosive liquid, basic, 1 DF 00126 P 128 D002 <br /> 0 organic, n. o. s. (Sodium Hydroxide, Potassium <br /> Hydroxide), 8 PG II (D0.02) ERG#153 <br /> Z 2. <br /> LU <br /> U) <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions and Additioralinformation I. 109732.(Basie / Corrosive / Organic Loosepack) <br /> t <br /> t <br /> 15. GENERATOR'S/ RTIFICATION I hereby dffdarethat Wowf6h6 ofconsfgrmentan,fully and accurately desoilied above by the proper shipping name,and are classified,packaged, <br /> marked and labbled/00carded;:andaF9 utati respects-iri pr6per contliti fortiarisportaccording to applicable intemationaland national governmental regulations.If export shipment and I am the Nmary <br /> Exporter,I certifythat the contelits oi'r tssignmentoxifbrrlm'fdthetemsbf the attacked EPAAckngwl6dgment of Consent. <br /> an s <br /> I certify that the waste muudiii2ttatri m`ceneet identified,In4OCFR'9227(a)'(dl am a large quantilygenerator)or(b)(if I am a suraln enerator)is true. <br /> Generators/ erors Pri ame 1 Sig re Month Day Year <br /> r 16.InternationgShoments <br /> 07 10.. <br /> Import to U.S. ❑Export from U.S. Port of entry/exit <br /> i Transporter signature(for exports only): Date leaving U.S.: <br /> 17.Transporter Ac mowedgment of Receipt of Materials <br /> Transporter 1Pnnted/TypedName Signatur6 Month Day Year. <br /> ' Demarco Brodnax ,.�^- 07. 10 . 019 <br /> Transporter 2 Pnnted/T Signafur Month Day Year <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space 0 Gkrantity LJ Type ❑Residue ❑Partial Rejection ❑Full Rejection <br /> 18b.Alternate Facility(or Generator) Manifest Reference Number. U.S.EPA ID Number <br /> Facility's Phone: <br /> 18c.Signature ofAltemate Facility(or Generator) Month Day Year <br /> 19.Hazy ste <br /> Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposa),and recycling systems) <br /> 11 i V 2. <br /> 3 4 <br /> 20.Designated F or Aerator, rtification of race f hazardous materials covered by the manifest exc,4 as noted in 18a <br /> Pdnted/Typed aura Signature Month Day Y <br /> P-R7M_79 ID- 19 17\ <br />