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Please print or type. 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) CAL000152025 2 006959863SKS <br /> 24.Generator's Name <br /> JC Trucking Inc <br /> Number <br /> 25. Transporter 3 Company Name Clean Harbors Environmental Services,Inc. MAD039322250 <br /> 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 Wt.Nol. <br /> � F-1O <br /> Q <br /> W <br /> z <br /> LU <br /> 1-1 — <br /> c� <br /> 1-1 <br /> 1-1 <br /> 1-1 <br /> 32.Special Handling Instructions and Additional Information <br /> 33.Transporter 3 Acknowledgment of Receipt of Materials <br /> H Printed/Typed Name Signature Month Day Year <br /> 0 <br /> O Morris L Rasciner Morris L Rasciner 03 15 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 /> LL <br /> C <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 /> [N <br /> W <br /> EPA Form 8700-22A(Rev.12-17) Previous editions are obsolete. DESIGNATED FACILITY TO EPA's e-MANIFEST SYSTEM <br />