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Please pdnt or type. Form Approved,OMB No.2050-0039 <br /> UNIFORM HAZARDOUS WASTE MANIFEST 21.Generator ID Number 22.Page Manifest Tracking Number <br /> (Continuation Sheet) CAL000152025 2 006959628SKS <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 /> U.S.EPA ID Number <br /> 26.Transporter 4 Company Name Clean Harbors Environmental Services,Inc. MAD039322250 <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 /> ❑ 1 <br /> I <br /> F-1F] 9 201D <br /> -- <br /> LU <br /> W <br /> I <br /> F-1 - <br /> I <br /> i <br /> ❑ - --- - � - - i <br /> ❑ O <br /> i <br /> ❑ ( I <br /> I <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter 3 Acknowledgment of Receipt of Materials <br /> LU Printedfryped Name Signature Month Day Year <br /> O <br /> Dale Stonewall Dale Stonewall 02 28 2019 <br /> n. <br /> z 34.Transporter 4 Acknowledgment of Receipt of Materials <br /> Printedrryped Name Signature Month Day Year <br /> Richard Stribling Richard Stribling 03 11 2019 <br /> 35.Discrepancy <br /> U <br /> Q <br /> u. <br /> Q36.Hazardous Waste Report Management Method Codes(i.e.,codes for hazardous waste treatment,disposal,and recycling systems) <br /> Z <br /> 0 <br /> Lu <br /> 0 <br /> EPA Form 8700-22A(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPXS 8-MANIFEST SYSTEM <br />