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Please print_or type. Form designed for use on elite 12 itchtypewriter.) Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 1 21 Generator ID Number 22.Page 23.Manifest Tracking Number <br /> (Continuation Sheet) CAL000207935 rv1 00639I 72SKS <br /> 24.Generator's Name <br /> AUrr0Z0NE 0r33?6 SAME <br /> BEDROCK INC DBA TSMT CO U.S.E`46 5038998 <br /> 25 Transporter, Company Name M <br /> 26. Transporter Company Name U.S.EPA ID Number <br /> 27a. 27b.U.S.DOT Description(including Proper Shipping Name,Hazard Class,ID Number, 28.Containers 29.Total 30.Unit 31.Waste Codes <br /> HM and Packing Group(if any)) No. Type Quantity Wt.Nol. <br /> O <br /> !;i W TPO <br /> z <br /> W <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter Acknowledgment of Receipt of Materials <br /> W Printed/Typed Name Signatu Month Day Year <br /> o _IEEE i FAVII? 91 281 18 <br /> Z34.Transporter Acknowledgment of Receipt of Materials <br /> Printed/Typed Name Sicnature Month Day Year <br /> F— <br /> } 35.Discrepancy <br /> J <br /> U <br /> Q <br /> LL <br /> 0 <br /> W <br /> Q 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> z <br /> c� <br /> V5 <br /> W <br /> 0 <br /> EPA Form 8700-22A(Rev.3-05) Previous editions are obsolete. DESIGNATED FACILITY TO DESTINATION STATE(IF REQUIRED) <br />