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Tracking Document Number: <br /> ACT tD107753 03104/2016 <br /> Advanced Chemical Transport <br /> Medical Waste TrackingDocument <br /> GENERATOR INFORMATION <br /> Manteca U.S.S.D. ( terra Flip) Kinibcrly Wright <br /> Facility Name: Contact Name: <br /> Address: <br /> 170D Ib moa St, Maotoca,CA 95337 ( ) <br /> Phone: 825AW60 <br /> SHIPPING INFORMATION (A=Autoclave, 1=Incineration, M=Microwave) <br /> Shipping Description(s) Number of Container Estimate Actual Treat- <br /> Containers T . e Wei htWei h Ment <br /> tl l <br /> Regulated Medical Waste 6.2, UN 3291,PG II <br /> • Regulated Medical Waste 6.2,UN 3291,PG II(Pathological Waste) ;� r `] P % P Inrin <br /> Regulated Medical Waste 6.2,UN 3291,PG 11(Chematheropy Waste) <br /> ' Nan-Reguiated or Expired Pharmaceuticals <br /> Other(specify): <br /> Transporter: Advanced Chemical Transport, Inc. <br /> California Hazardous Waste Registration # 4026 <br /> E210 Elko Drive ❑ 2213 Meyers Avenue <br /> Sunnyvale, CA 94089 Escondido,CA 92029 I <br /> Phone (40B) 548-505D Phone(760) 4895600 <br /> MWTS Per#TS-42 MWTS Per#TS-64 Sign6tu}e&Dare LL <br /> Name: <br /> Secondary Transporter: <br /> Address: <br /> Phone: Signature&Dare <br /> Generator's Certification: <br /> This is to certify that the materials described above are properly classified,packaged,marked and labeled and are in proper condition for transportation in accordance <br /> with the applicable regulations of the United States 1 X y <br /> Department of Transportation and the State of California. t' <br /> Signati-e&Dete 24-hour Emergency Phone# <br /> (Tr=Treatment, Ts=Transfer) Destination Facility: <br /> ❑ Stericycle,Inc. ❑ Charnhers County Resource ❑ Sanitec USA ❑ Sanitec USA ❑ Stericycle,Inc. <br /> Tr/Ts Station Recovery and Recycling Facility Tr/Ts Facility Ts Station Tr/Ts Station <br /> 1345 Doolittle Drive,Suite C Tr/Ts Station 9065 Norris Avenue 2900 Apron Avenue#1260 2775 fast 261h Streel <br /> Son Leandro,CA 94517 7501 Stale Highway 65 Sun Volley,CA 91352 Atwater,CA 95301 Vernon,CA 90023 <br /> (510)636-9502 Anohum,TX 77514 (818)504.0343 (209)388-0285 (323)362.3000 <br /> MWTS Per#19.23-P (888)877-8103 MWTS Pelf TS/OST 20 MWTS Per#TS-45 MWTS Per#p-115 <br /> MWTFPer#1A1thµis S fV 0`#TNRCC MSW#2239A <br /> �C?� THIS IS TO CERTIFY THAT THE WASTE IDENTIFIED <br /> ❑ <br /> Other; '0362% <br /> % ABOVE WAS RECEIVED AT THE DESTINATION FACILITY <br /> CHECKED ABOVE. <br /> - Signature d Date <br />