Laserfiche WebLink
• . t 4. <br /> $HARPS. <br /> .compliance, Inc. 3797247 <br /> TakeAwayTm Recovery System Tracking Document <br /> Complete sections 1 through 5 on this triplicate form. Keep"Shipper" (bottom) copy of <br /> completed form for your records, place remaining copies in the plastic pouch on the outside of <br /> the box. For detailed instructions, information regarding contents, and training purposes, see <br /> Packaging and Shipping instructions enclosed in this shipping box or visit our website at <br /> www.sharpsinc.com. <br /> All items below must be filled out completely. <br /> 1. <br /> Shippers printed name complete address&telephone: <br /> Hard Luck Tattoo <br /> 7 N Sacramento St <br /> Lodi, CA 95240 <br /> Product - 80030 <br /> 2.Description of Contents:Used Healthcare Materials 3.Signature of Shipper(Fir;a) <br /> 4.Date Shipped(Fecha de Envio) 5. weight of Packaged Box(Peso de la caia empaquetada) <br /> i <br /> TRACKING FORM(MANIFEST) DIRECTIONS FOR SHIPPER <br /> Check above, everything must be filled out completely.YOU MUST SIGN#3 ABOVE. <br /> Keep"Shipper" (bottom)copy for your records. <br /> Make sure#3 is signed and#4 is completed with the date container was shipped. <br /> Put this Tracking Form in the provided ziplock bag on the outside of box and seat <br /> Comments <br /> TO BE COMPLETED BY DISPOSAL SITE ONLY <br /> Printed certification of receipt and processing: "I certify that the contents of this container have been <br /> received,treated and processed in accordance with all local,state,and federal regulations." <br /> Treatment Facility'. Check the box of the corresponding facility <br /> j <br /> ❑ HealthWise <br /> ❑ Sharps Environmental Services,Inc. 4800 E.Lincoln Ave <br /> 1544 NE_Loop Fowler,CA93623 -+^-�•- <br /> '. Carthage,TX 75633 Permit NO.TS-89 <br /> Permit NO.40267 <br /> ❑ Other: <br /> ❑ Alpha Bio-Med Services,LLC <br /> 600 Industrial Road <br /> Nesquehoning,PA 18240 <br /> Permit NO.400696 <br /> f <br /> IN CASE OF EMERGENCY,OR DISCOVERY OF DAMAGE OR LEAKAGE, <br /> CAL11.840.772.5657 - <br /> r_ <br /> -L---4L 0:4—1 oinit=Chinnar Part#100163RevI <br />