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qelit-tou-/ <br />Form Approved. OMB No. 2050-0039 <br />N._ <br />Please pnnt or type. Phone 4. Manifest Tracking Number <br />A UNIFORM HAZARDOUS <br />WASTE MANIFEST <br />1 Generator ID Number <br />C A R 0 0 0 2 6 6 2 2 -1 <br />2 Page 1 of <br />-i, <br />3. Emergency Response <br />877-577-2680 0 2 0 4 0 9 8 8 4 JJK <br />Generator's Name and Mailing Address Generators Site Address (if different than mailing address) <br />Amazon SJC7 <br />188 International Pkwv <br />Tracy CA 95377 <br />Generator's Phone: 8 7 7 5 7 7 - 2 6 6 9 I <br />Transporter 1 Company Name U.S EPA ID Number <br />Patriot Environmental Services 'CAD() 5 3 8 6 6 7 9 4 <br />Transporter 2 Company Name - U.S. EPA ID Number <br />(4/"Ca C la b...) Cc-41-c_ `5.c.) I C41-1' ) I) I it4-105" e . 00 Ii 0 9' Z/t <br />Ad (l <br />e‘e- <br />. evgnated Facility Name and Site re U.S. EPA ID Number <br />21st Century EMI <br />2095 Newlands Drive East <br />Fernley. NV 89408 <br />Facility's Phone: 775 675-2760 INVD 9 8 <br />\ <br />) 8 9 5 3 3 8 <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 />Hy and Packing Group Of any)) No. Quantity Wt.Nol. <br />x 'UN3264, WASTE Corrosive Liquid, Acid, Inorganic, N.O.S., (Sulforic <br />ii:Fri <br />1.0f- / rip 791 D002 <br />c8 I- a cc <br />Acid, Hydrochloric Acid), 8, PG II 3 <br />-DM" P <br />/ , <br />Li., ,-- <br />z <br /> <br />. <br />IS 2 • _ r • .1. _ I // a SP 'II <br />. ,..• • I' -21e <br />4 - <br />3. UN ter+)Viach,12)4V-riAbS <br />1 <br />Ve4-I i-vect vil Aeleti 100 e vat. • <br />Ci\keptiov4i t e 2- Df. <br />1 <br />4 <br />14. Special Handling Instructions and Additional Information 1)9b.1) 109715SP-06 <br />2-CV0' 3) I ( 1et-39-5PO4 <br />Always wear appropriate PPE when handling waste. JOB# 09-22-00134 <br />15 GENERATOR'S/OFFEROR'S CERTIFICATION: I hereby declare that the contents of this consignment are fully and accurately described above roper shipping name, ard are classified, packaged. <br />marked and labeled/placarded, and are in all respects in proper condition for transport according to apolicable intemational and national gave.- ental t lations. 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 minimlzation stat ent identified in 40 CFR 262.27(a) (i'l I arm a large guantty generator) o • .m a s AP ene r) is true. <br />Generators e r's Printed Typed Narr . 1 Sign.' Month Day Year <br />Y ,,,r itvl <br />_, International Shipments 11_. Export from U.S. Port of entrytexit: r- <br />K <br />Import to U.S. <br />Transporter signature (for exports only): Date leaving U.S.: TRANSPORTER I Transporter Acknowledgment of Receipt of Materials <br />Tran orter 1 Printed/Typed Name Signature Month D.21 Year <br />los-ii-i12/ <br />Tran ortel 2 Printedrryped Name 4 Signature <br />- " r 2- - to itt_ k-.., (>-.71.. <br />i i ---7 Month Day Year <br />Z2--- DESIGNATED FACILITY 18.tiscrepanc <br />Discrepancy Indcaticr Space Quantity D Type Residue Pi Partial Rejection Li Full Rejector, <br />Manifest Reference Number: <br />Alternate Facility (o, 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 />Hazardous Waste Report Management Method Codes (i.e., codes for hazardous waste treatment, disposal. and recycling systems) <br />1 2. 3. <br />Designated Facility Owner or Operator, Certfica on of receipt of hazardous materials covered by the manifest except as Wed in Item 18a <br />1.1r6d\ <br />1117Eyped Name <br />)b <br />Month Day Year <br />I , _.,tn . : r I (Di.- 3 i 1 . ___........,,r, r• A , I I e-rx, ,r, —r. A — — IA A lk II CCCT CVCTC14/1 <br />EPA Form 8700-22 (Rev. 12-17) Previous editions are obsolete.