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m <br /> Please print or type. For 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 CAL000429774 1 1 <br /> (877) 577-2669 F L E <br /> 5.Generator's Name and Mailing Address Generator's Site Address(if different than mailing address) <br /> Amazon.com Services, Inc. (DCK1) Amazon. cogi 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 /> Stericycle Specialty Waste Solutions Inc MNS0001109`4 <br /> 7.Transporter 2 Company Name U.S.EPA ID Number <br /> 4e-&f� 6D <br /> 8.Desi ated Facility Name and Site Addres%21 s Cent ury EMN, LLC U.S.EPA ID Number <br /> 2095 Newlands Dr. East <br /> Fernley, NV 89408 <br /> Facility's Phone:7755752760 INVD980895338 <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 Wt.Nol. <br /> X ON3267, Waste Corrosive liquid, basic, 1 DF 00158 P 122 D1102 <br /> 0 organic, n, o. s. (Sodium Hydroxide, Potassium <br /> Hydroxide) , 8 PG II ERG#153 <br /> LU <br /> Non RCRA hazardous waste, liquid (Unused Oil), 1 DF 00213 P 343 <br /> 3. <br /> 4. <br /> 14,Special Handling Instructions and Additional Information 1. 109732(Basic / Corrosive / Organic Loosepack) 2. 109758(Used <br /> Oil & Misc. ) <br /> 15. GENE RATOR'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 inlemationaland 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 EPAAc knowfedgment of Consent. <br /> I certify that the waste minimization statement identified in 40 CFR 262.27(a)(if 1 am a large quantity generator)or(b)lift am a small quantity generator)is true. <br /> Generatcr's/Offeroe Printed d Name Month Day Year <br /> 12 26 019 <br /> F-- 16.International Shipments EJimport to U.S. <br /> rt of <br /> ❑Export from U.S. Poentry it: <br /> ? Transporter signature(for exports only): Date leaving U.S.: <br /> UJ 17.Transporter Admwledgment of Receipt of Materials <br /> Transporter 1 Printed/Typed Name Signature Month Day Year <br /> COL Isidro Martinez 12 26 019 <br /> ti <br /> Q Trans rter Pdnted/Typed Nam Signature Month Day Year <br /> a <br /> 18.D pancy <br /> 16a.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 /> U <br /> I Facility's Phone: <br /> C3 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> / <br /> 1 14/141gI 2 h q/ 3. 4. <br /> 1 <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 /(p �,,-�.y�� � Month �y Year <br /> EPA Form 8700-22(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EP A's e-MANIFEST SYSTEM <br /> n-7rara_0a ♦o..-: r00-7S004 Chi 01A0t77A nhi F.PS157 M PT)1?PF.19 RD1pp619 <br />