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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 013401674FLE <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 /> Rho Chem LLC CAD008364432 <br /> 425 Isis Ave. <br /> Inglewood CA,90301 <br /> Facility's Phone: 323-776-6233 <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(if any)) No. Type Quantity Wt./Vol. <br /> 1.UN3266,Waste Corrosive liquid,basic,inorganic,n.o.s.(Sodium Hydroxide,Potassium D002 <br /> Hydroxide), 8,PG II,ERG#154 <br /> 0 1 DF 156 P <br /> dl23 <br /> Z 2. <br /> Lu <br /> 0 <br /> 13, <br /> 4. <br /> 14.Sppecial Handling Instructions and Additional Information <br /> 1)109716(Alkaline Liquid LoosePack);Line 1: <br /> 15. GENERATOR'S/OFFEROR'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 Printed[Typed ame Signature Month Day Year <br /> Alex Orellano Alex Orellano 06 13 2019 <br /> —J 116.International Shipments <br /> F ❑Import to U.S ❑Export from U.S. Port of entry/exit: <br /> Transporter signature for exports only): Dale leaving U.S.: <br /> W 17.Transporter Acknowledgment of Receipt of Materials <br /> Transporter 1 Pdntedrfyped Name Signature Month Day ear <br /> a Isidro Martinez Isidro Martinez 06 13 2019 <br /> Q< Transporter 2 Printedrryped Name Signature on ay Year <br /> Andres M. Andres M. 06 13 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 /> Facility's Phone: <br /> Lo 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> z <br /> N19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> C 1 2 3, 4. <br /> H141I I <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 06 25 2019 <br /> EPA Form 8700-22(Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />