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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 014010738FLE <br /> 5.Generator's Name and Mailing Address Generators Site Address(if different than mailing address) <br /> AMAZON.COM SERVICES,LLC DCK1 2403 WEST LOUISE AVE <br /> P.0 BOX 80842 MANTECA CA,95337 <br /> SEATTLE WA,98108 <br /> Generator's Phone: 206413-4526 <br /> 6.Transporter I Comp-a-nylTa-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 /> 21st Century Environmental Management of Nevada,LLC NVD980895338 <br /> 2095 Newlands Drive East <br /> Fernley NV,89408 <br /> Facility's Phone: 775-575-2760 <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)) <br /> No. Type Quantity WtJVoI. <br /> 1.UN3267,Waste Corrosive liquid,basic,organic,n.o.s.(Sodium Hydroxide,Potassium D002 <br /> Hydroxide), 8,PG II,ERG#153 1 DF 158 P <br /> 122 <br /> Z 2.Non RCRA hazardous waste,liquid(Unused Oil), <br /> w <br /> CD 1 DF 213 P <br /> [343 <br /> 3. <br /> 4. <br /> 14.Sppecial Handling Instructions and Additional Information <br /> 1)109732(Basic/Corrosive/ Organic Loosepack)2)109758(Used Oil&Misc.);Line 1:Line 2: <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 PrintedfTyped Name Z51gnature Month Day Year <br /> Gerald Preston Gerald Preston 12 26 2019 <br /> .j 16.International Shipments <br /> Import to U.S ❑Export from U.S. Port of entry/exit: <br /> Z Transporter signature for exports only): Date leaving U.S.: <br /> w 17.TransporterAcknowledgment of Receipt of Materials <br /> Transporter 1 Printecirryped Name Signature Month Day Year <br /> Isidro Martinez Isidro Martinez <br /> p,O 12 26 2019 <br /> QTransporter 2 Printedrryped Name Signature month Day Year <br /> W Miguel Escalate Miguel Escalate 12 1 26 1 2019 <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 /> V <br /> LL Facilitys Phone: <br /> Lo 18c.Signature of Alternate Facility(or Generator) Month Day Year <br /> Q <br /> Z <br /> 55 19.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> G 1. 2. 3. 4. <br /> H141 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 /> Alma Luoto Alma Luoto 01 08 2020 <br /> EPA Form 8700-22(Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />