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Please print or type. Form Approved.OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21•Generator ID Number 22.Page Mani est Tracking um er <br /> (Continuation Sheet) CAL000152025 2 006776967SKS <br /> 24.Generators Name <br /> JC Trucking Inc <br /> Number <br /> 25. Transporter 3 Company Name BED ROCK INC DBA TRI STATE MOTOR TRANSIT CO MOD095038998 <br /> .EPA D Number <br /> 26.Transporter Company Name <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 WtJVoI. <br /> ❑ - <br /> ❑ 1 J <br /> F-1 <br /> I J <br /> 0 <br /> L I_ <br /> I <br /> ❑ L l <br /> ❑ <br /> ❑ i <br /> I <br /> ❑ - i <br /> I <br /> ❑ <br /> i <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter 3 Acknowledgment of Receipt of Materials <br /> FW- Printed(ryped Name Signature Month Day Year <br /> �2 Dan Stone Dan Stone 02 26 2019 <br /> a <br /> Z 34.Transporter-Acknowledgment of Receipt of Materials <br /> Printed/typed Name Signature Month Day Year <br /> F. <br /> 35.Discrepancy <br /> J <br /> U <br /> Q <br /> LL <br /> W <br /> W <br /> a 36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> z <br /> C7 <br /> C/) <br /> W <br /> 0 <br /> EPA Form 8700-22A(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's 9-MANIFEST SYSTEM <br />