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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 012952983FLE <br /> 5.Generators 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 /> Generators Phone: 206-413-3526 <br /> 6.Transporter t CompanyRa-me 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 /> Rho Chem LLC CAD008364432 <br /> 425 Isis Ave. <br /> Inglewood CA,90301 <br /> Facilitys Phone: 323-776-6233 <br /> 9a 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 10.Containers 11.Total 12.Unit 13.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> I.RQ,UN3267,Waste Corrosive liquid,basic,organic,n.o.s.(Sodium Hydroxide, D002 <br /> Potassium Hydroxide), 8,PG 11,(D002),ERG#153 1 DF 126 P <br /> O 122 <br /> Z 2. <br /> w <br /> C9 <br /> 3. <br /> 4. <br /> 14.Sppecial Handling Instructions and Additional Information <br /> 1)109732(Basic/Corrosive/ Organic Loosepack);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 EPA Acknowledgment 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 ype Name gna ure on ay ear <br /> Salinder Singh Salinder Singh 07 10 2019 <br /> 116.International Shipments Import to U.S El Export from U.S. Part of entry/exit: <br /> F- <br /> Transporter signature for exports only): Date leaving U.S.: <br /> 17.Transporter terAcknowedgment of Receipt of Materials <br /> Signaturemar on ay Year <br /> 12 Transporter 1 Printed/Typed Name <br /> CO Demarco Brodnax Demarco Brodnax 07 10 2019 <br /> U) <br /> Transporter PrintedfTyped Name -Signalure on ay Year <br /> < Art A. Art A. 07 10 1 2019 <br /> l- <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space D Quantity ❑Pype ❑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 <br /> Facilitys Phone: Month Day Year <br /> Li 18c.Signature of Alternate Facility(or Generator) <br /> Q <br /> Z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1. 2. <br /> 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 /> Gina Webb Gina Webb 07 24 2019 <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />