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I IN 111111 INIl111 Form Approved.OMB No.2050-0039 'lease print or type. 2 Page 1 ofency pgnse Ph onMa e 4. nifest Tracking Number UNIFORM HAZARDOUS 'C It fc�f L x}74 9r) ( : J FLE 1 WASTE MANIFEST ,q c:- r 5.Generators Name and Mailing A res& Generators Site Address(i eqt h n mailino ad ass { Inc. (DCN 1) amazon. coni Services, Inc. (DCN.i) �h��d�. colt �e>?,vice_, (209) 205-0080 2403 West Louise Avenue 2403 West Louise Avenue Manteca, CA 95337 Manteca, CA 95337 Generators Phone: U.S.EPA ID Number 6.Transporter 1 Company Name MNS0001 10924 StericVcle Specialty Waste Solutions Inc U.S.EPA ID Number 7.Transporter 2 Company Name B.Designated Facility Name and Site Address ben era I Environmentalg , U.S.EPA ID Number 11855 White Rock Road Rancho Cordova, CA 957421: Facility's Phone: 9163510980 CAD98O884183 9b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,to Number, 10.Containers 11.Total 12.Unit 13.Waste Codes 9a' Type HM and Packing Group(if any)) No. Quantity Wt.Nol. as a er•oso s, anima e, eac no k 3 P 3 1 O exceeding 1 L capacity) ] 2. 1, ERG#126 i t UJ 2. LU c� 3. 4. r 14.Special Handling Instructions and Additional Information 1. 109718(Flammable Aerosols) 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,ani are classified,packaged, 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 Exporter,I certify that the contents of this consignment conform to the terms of the attached EPA Acknowledgment of Consent. I 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. Month Day Year Generators/Offerors Printed/Typed Name Signature ;ell 1111"1 n0 021-117120 16.International Shipments ❑Import to U.S. ❑Export from U.S. Port of entry/exit: F— Date leaving U.S.: ? Transporter signature(for exports only): W 17.Transporter Acknowledgment of Receipt of Materials Month Day Year LLJTransporter 1 Printed/Typed Name Si 01 102 1-020 5. Isidro Martinez Moron Day Year Z Transporter 2 Printed/Typed Name re 18.Discrepancy 18a.Discrepancy Indication SpaceQuantity Type ❑Residue ❑Partial Rejection ❑Full Rejection ❑ ❑ Manifest Reference Number: U.S.EPA ID Number 18b.Alternate Facility(or Generator) J U Facility's Phone: Month Day Year U0 1=Signatureate Facility(or Generator) Q z S2 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) 4 LU 1� l 2. 3. 20.Designated Facility Owner or Operator.Certification of receipt of hazardous materials covered by the manifest Signature Month as noted in Item 18a Month D Printed/Typed Name „1 ci—sin—arllfinnc ora obsolete. ryF �t`lpT� FEPA's e•MANIFEST SYSTEM