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Please print or type. Form Approved. OMB No. 2050-0039 GENERATOR I UNIFORM HAZARDOUS WASTE MANIFEST 1. Generator ID Number CAR000245092 2. Page 1 of 3 3. Emergency Response Phone 877-577-2669 4. Manifest Tracking Number 015096253FLE Generators Name and Mailing Address Generators Site Address (if different than mailing address) AMAZON.COM SERVICES LLC (OAK4) 1555 N Chrisman Road Tracy CA, 95304 Generators Phone: 775-575-2760 I Transporter 1 Company Name U.S. EPA ID Number Stericycle Specialty Waste Solutions Inc 1MNS000110924 Transporter 2 Company Name U.S. EPA ID Number I Designated Facility Name and Site Address U.S. EPA ID Number 21st Century Environmental Management of Nevada, LLC NVD980895338 2095 Newlands Drive East Fernley NV, 89408 Facility's Phone: 775-575-2760 I 9a. 9b. U.S. DOT Description (including Proper Shipping Name, Hazard Class, ID Number, 10. Containers 11. Total 12. Unit Waste Codes 13. HA and Packing Group (if any)) No. Type Quantity Wt.Nol. UN1362, Waste Carbon, activated (Carbon, Activated), 4.2, PG III, ERG#133 0001 0003 1 DM 78 P X 141 RQ, NA3077, Hazardous waste, solid, n.o.s. (Mercury), 9, PG III, (0009) 1 OF 24 P D009 >r<1 181 UN1325, Waste Flammable solids, organic, n.o.s. (Acetone, Charcoal), 4.1, PG II, D001 0006 0035 A ERG#133 1 OF 72 P 331 UN2903, Waste Pesticides, liquid, toxic, flammable, n.o.s. (Aromatic Hydrocarbon, - \( Permethrin), 6.1 (3), PG II, ERG#131 OF 202 P D001 LI. 331 14. Special Handling Instructions and Additional Information 12)109728(Acidic / Corrosive / Organic LoosePack) 2)109733(Broken Light Tubes & Bulbs) 9)109741(Waste Flammable Liquid) 3)109743(Flammable Solid LoosePack) 13) 109758(Used Oil & Misc.) 14)109768(Oily Solids, Rags and Debris) 5)109773(CA Liquid Pharmaceuticals) 6)109775(CA Solid Pharmaceuticals) 11)109775(CA Solid Pharmaceuticals) 10)109778(Liquid Hypochlodtes / Bleach) 4)109787(Pesticide Liquids Loosepack) 8)109788(Pesticlde Solid Loosepack (Non-RCRA)) 7)110470SP (Charlie's Soap Oxygen Bleach) 1)111585(Natural Moso Bamboo Charcoal) ; 15. GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby dedare that the contents of this consignment are fully and accurately described above by the proper shipping name, and 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 lam the Primary Exporter, I certify that the contents of this consignment conform to the terms of the attached EPAAcknowledgment of Consent. I certify that the waste minimization statement identified in 40 CFR 262.27(5) (if I am a large quantity generator) or (b) (if I am a small quantity generator) is true. Generators/Offeror's Printed/Typed Name Signature Month Day Year Vanessa Abilez 1 Vanessa Abilez 1 12 I 07 1 2020 --r I- z - 16. International Shipments • Import to U.S Export from U.S. Port of entry/exit: Transporter signature (for exports only): Date leaving U.S.: TRANSPORTER 17. Transporter Acknowledgment of Receipt of Materials Transporter 1 Printed/Typed Name Signature Month Day Year Jesus A Marquez Ortega 1 Jesus A Marquez Ortega 1 12 1 07 1 2020 Transporter 2 Printed/Typed Name Signature Month Day Year I I I I DESIGNATED FACILITY I 18. Discrepancy Discrepancy Indication Space Quantity laPe Residue Partial Rejection Full Rejection Manifest Reference Number: Alternate Facility (or Generator) U.S. EPA ID Number Facility's Phone: I Signature of Alternate Facility (or Generator) Month Day Year I I I 19. Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal, and recycling systems) 1. H141 2. H141 3. H141 4. H141 20. Designated Facility Owner or Operator Certification of receipt of hazardous materials covered by the manifest except as noted in Item 18a Printed/Typed Name Signature Month Day Year Alma Luoto 1 Alma Luoto 1 12 1 18 1 2020 EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM