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24-Hour Emergency Phone Tracking Document Number: <br /> �0 Number: 888-785-7225 D174SG4 <br /> ACT ' Medical Waste Tracking Document <br /> environmental services <br /> oFacility Nam Manteca Urifled School District Perr3�N �t Name: Kimberty WrigN <br /> Tho Thomas St <br /> W Z Address: Manteow, CA 95337 Phone: 209-858-0860 <br /> �z <br /> }r Shipping Description(s) #of Cont. Cont. Size Estimated Actual *Treatment <br /> Type Weight Weight <br /> UN 3291, Regulated Medical Waste,N.O.S. <br /> 6.2,PG II <br /> UN 3291, Regulated Medical Waste, N.O.S. h f <br /> F 31 b <br /> F 6.2 , PG 11 (Pathological Waste) j J � <br /> d <br /> a UN 3291, Regulated Medical Waste, N.O.S. <br /> 6.2,PG II (Chemotherapy Waste) <br /> Z <br /> 0 <br /> Z Non-Hazardous Pharmaceutical Waste <br /> x <br /> rn <br /> Non-Regulated <br /> Other(specify): <br /> 'A=Autoclave, 1=Incineration, M=Microwave <br /> Advanced Chemical Transport,Inc. CA Hazardous Waste Registration:4026 <br /> 1210 Elko Drive,Sunnyvale,CA 94089 EPA ID#:CAR000070540 <br /> Ir z Motor Carrier Permit:0194741 <br /> ❑ 1210 Elko Drive ❑ 2010 Mission Ave. 265 Riggs Avenue ❑ 13722 Carmenita Road <br /> Sd <br /> Sunnyvale,CA 94089 Escondido,CA 92029 Merced,CA 95341 Santa Fe Springs,CA 90670 <br /> LL_ 408-548-5050 760-489-5600 209-722-4228 714-545-2191 <br /> ~ MWTS Permit#TS-42 MW`-rSf erm'W - 1D0 MWTS Permit#TSS <br /> Print Name r- 4� h <br /> 1J9J Signature: Date: INI-t <br /> A <br /> 6 Name: DOT#: <br /> Address: State Transporter#or Permit: <br /> UjN <br /> ~. 'Print Name: Signature: Date: <br /> Z I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> O Q marked and labeled,and are in all respects in proper condition for transport according to applicable governmental regulations. I certify that this shipment does <br /> a not contain regulated hazardous and or radioactive waste. I am aware that there are significant penalties for submitting false information including the possibility <br /> o of fines and imprisonment. <br /> Lu LL <br /> LU x <br /> 0 LU <br /> Ignature: ,�4� not Name: ate: J <br /> © Advanced Chemical Transport ❑ ACT Medical Advanced Chemirai Transport Ll Advanced hejiticaa transport <br /> 1240 Elko Drive 2010 Mission Ave. 265 Riggs Avenue - 1E2 nit d, <br /> W z Sunnyvale,CA 94089 Escondido.CA 92029 Merced,CA 95341 Santa Fe Springs,CA 90670 <br /> "O 408-546.5050 760489-5600 209.7224228 714-545-2191 <br /> NF <br /> Q MWTS Permit#TS42 Permit#TSIOST-66 MWTS Permit#TS-100 MWTS Permit 9 TS-8 <br /> R to <br /> ~ THIS 15 TO CERTIFY THAT THE WASTE IDENTIFIED ABOVE WAS <br /> RECEIVED AT THE TRANSFER FACILITY CHECKED ABOVE. Signature&Date: <br /> ❑ ACT Medical Healthwise Services Medical E] Waste Management Healthcare ElOther <br /> z 2010 Mission Road Waste Disposal Solutions <br /> D Escondido,CA 92029 4800 E.Lincoln Ave Fowler 4280 Bandinl Blvd <br /> 760489-5800 Callfornia 93625 Vernon,CA 90058 <br /> =v Permit#TS?OST-66 559-834-3333 323-307-0514 <br /> Ym LL Permit#TS-39 Permit#TWOST-81 <br /> D THIS IS TO CERTIFY THAT THE WASTE IDENTIFIED ABOVE WAS <br /> RECEIVED AT THE DESTINATION FACILITY CHECKED ABOVE Signature&Date: <br />