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'lease 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.Mantfest Tracking Number <br /> WASTE MANIFEST CAL000429774 . 1 <br /> . (877). 577-2669 ` 013401674 FLE <br /> 5.Generators Name and Mailing Address Generabrs Site Address(i(different than mailing address) <br /> _ .Amaz.on..com.._Services, Inc. (DCK1) Amazon.co■ Services, Inc. (DCK1) <br /> (209) 205-0080 2403 West Louise Avenue 2403 West Louise Avenue <br /> Generators Phone: Manteca, CA 95337 Manteca, CA 95337 <br /> 6.Transporter 1 Company Name U.S.EPA ID Number <br /> Stericycle Specialty Waste Solutions Inc MNS000110924 <br /> 7.Transporter 2 Company Name U.S. PAZNumber <br /> 8.Designated Facility Name and Site Address Rho em, U.S.EPA ID Number <br /> 425 Isis Avenue <br /> Inglewood, CA 90301 <br /> Facility's Phone: 3237766233 CAD008364432 <br /> ga 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(d any)) No. Type Quantity WuVol. <br /> r X 1.UN3266, Waste. Corrosive liquid, basic, 1 DF 00156 P 123 D002 <br /> inorganic, n. o. s. (Sodium Hydroxide, <br /> Potassium Hydroxide) 8 PG II ERG#154 <br /> z 2 <br /> L <br /> 3. <br /> 4. <br /> 14.Special Handling Instructions aria Additionalirifomtation 1. i09716(Alkaline Liquid LoosePack) <br /> 15. 'GENERATOR'$10FFEROR'S CERTIFICATION:I hereby declare that the contents of the consignment are fully and accurately desvibed above by the proper shlpping name,and are:classified;packaged, <br /> marked and labeledlplacarded,and are In all respects in proper condition for transport according to applicable tntemabQnaland national governmental regulations,If export shipment and I am the Fri#" _ <br /> Exporter,I certify that the contents of this consignment conform to the Ism>.s of the attached EPAAeknowledgment of Consent <br /> I certify that the waste.minimization statement Identified in 40 CFR 262,27(a)(If I am a large quantity generator)pr(b)(If]am a small quantitygenerator)is true. <br /> GeneratoeslOfferor's Prin �il yped N� Signature Month Day Year <br /> •� (�/ ! 061 13 201 <br /> y 16.International Shlpments <br /> ❑Import to U.S. ❑Export from U.S. Port of.entry/exlE <br /> Transporter signature(for exports only): Date(saving U,S.: <br /> 17.TransporterAdkroMecigment of Receipt of Materials . <br /> Transporter Pdn*VTyped Name Signature Month Day Year <br /> Isidro Martinez 1 061 131201! <br /> T iporter 2 Prin Name t rialure Mon Day. Year <br /> ' ZK I <br /> 18.Discrepancy <br /> 18a.Discrepancy Indication Space ❑ Quantity ❑Type ❑Residueejection ❑ <br /> ❑Partial R Dull Rejection <br /> Manifest Reference Number. <br /> 18b.Alternate Facility(or Generator) U.S.EPA ID Number <br /> i <br /> Facility's Phone: <br /> 16c.Sgnature of Alternate Facility(or Generator) Month Day Year <br /> 19.H ante Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recYdM systems) <br /> 20.Designat Owner or a or.Certification of r t of hazardous materials cove y the man t sept asped In item 18a <br /> PrintedrrName ` S' re Doth a Y <br /> 1 1 <br /> q] <br /> \Form 8700-22(Rev.12-17) Previous editionsar e. nGctr_AIA Gncncu•ITVTACDAI-w IAA AIICCCT.•QVCTt!Ifi <br />