|
<br />11 111 111
<br />
<br />II Please print or type.
<br />
<br /> GENERATOR k I UNIFORM HAZARDOUS
<br />WASTE MANIFEST
<br />1. Generator ID Number J2.
<br />CAR000245092
<br />..Page 1 of ., c
<br />3. Emergency Response Phone
<br />8775772669
<br />4. Mabesirsli briglir...
<br />176 FLE
<br />
<br />i I Si Generators Name and Mailing Address II I I • tt` 8arv t' Y ouldy M
<br />AMAZON.COM SERVICES LLC (OAK4)
<br />(209) 604-4148 1555 N Chrisman Road
<br />Generator's Phone: Tracy, CA 95304
<br />r Generators Site Address (if different than mailing address)
<br />AMAZON.COM SERVICES LLC (0AK4)#0
<br />1555 N Chrisman Road I Tracy, CA 95304
<br />Transporter 1 Company Name U.S. EPA ID Number
<br />Stericycle Specialty Waste Solutions Inc 1MNS000110924
<br />Transporter 2 Company Name U.S. EPA ID Number
<br />‹.. 7t-7i /'z- i 1 1 ,z- '7YL-Pti-.1 ii C - I 1714z) 6 S-6.18 2 Designated Facility Name and Site Address 21st Century EN, LLC U.S. EPA ID Number
<br />2095 Newlands Dr. East
<br />Fernley, NV 89408
<br />Facility's Phone: 7755752760 1NVD980895338
<br />ga. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12 Unit Hjyi and Packing Group (if any)) No. Type Quantity Wt.Nol. 13. Waste Codes
<br />X 1JN3265, Waste Corrosive liquid, acidic,
<br />organic, n.o.s. (Oxalic Acid, Glycolic Acid),
<br />8, PG II, ERG#153
<br />1 DF 00186 P 791 D002 ;
<br />X UN2588, Pesticides, solid, toxic, n.o.s.
<br />(Diazinon, Bifenthrin), 6.1, PG II, ERG#151
<br />1 DF 00220 P 352
<br />-
<br />X UN1791, Waste Hypochlorite solutions 8, PG II,
<br />ERG#154
<br />2 DF 00407 P 122
<br />-
<br />D002
<br />--
<br />X UN.6086, Waste Toxic solids, oxidizing, n.o.s.
<br />(Disodium Carbonate & Hydrogen Peroxide,
<br />1 DF 00142 P 141
<br />-
<br />D001 1
<br />---_--i
<br />Sodium Carbonate), 6.1 (5.1), PG II, ERG#141
<br />Special Handling Instructions and Additional Information 1.110'318(HC1d1C / Corrosive / Urganic LoosePack) 2.
<br />109788(Pesticide Solid Loosepack (Non -RCRA)) 3.109778(Liquid Hypochlorites / Bleach) 4.
<br />110470SP(Charlie's Soap Oxygen Bleach) (br)(br)
<br />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 />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 smpll quill., :• : -.erator) is true.
<br />Gener ors/Offerors Printed/Typed
<br />- ax-rssc,
<br />ame Signatur Month Day Year
<br />2,- k • I ii I 30 k020
<br />1-
<br />F.
<br />16. International Shipments
<br />Import to U.S. Export from U.S. Port of entry/-
<br />Transporter signature (for exports only): Date leaving U. TRANSPORTER 17. Transporter Acknowledgment of Receipt of Materials
<br />Transporter 1 Printed/Typed Name Signature ,. Month Day Year
<br />Isidro Martinez 1 11 130 P020
<br />Transporter 2 Printed/Typed Name Signature Month Day Year
<br />I -t_____ I 1 LI 4 I 4-- DESIGNATED FACILITY 18. Discrepancy
<br />Discrepancy Indication Space Quantity Type Residue Partial Rejection Full Rejection
<br />Manifest Reference Number:
<br />Alternate Facility (or Generator) U.S. EPA ID Number
<br />Facility's Phone: I
<br />Signature of Alternate Facility (or Generator) Month Day Year
<br />I I
<br />19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems)
<br />1. 2. 3. 4.
<br />20. Designated Facility Owner or Operator: Certifica ion of receipt of hazardous materials covered by the manifest except as noted in !tern 18a
<br />Printed/Typed Name Signature Month Day Year
<br />fill et- LL.A-4.47) I A I
<br />EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM
<br />8700-22_12v3 C8275924 941016504 041944753 M
<br />
<br />PD113020 0113020 _
|