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i <br />R"0110tod U"W <br />I <br />l <br />n: <br />UN3291, Regulated Medical Was+tei <br />-SHARPS SOLUTIONS n.o.s., 6.2, PGII <br />COMPANYNAME "Lei" <br />Tattoo (209)464.9774 <br />a <br />ADDRESS <br />cific Avenue Stockton, CA , > <br />hat the information provided is trueanid correct;and that the,generated materials aneprorclassified, described,' <br />T_A <br />, 0 <br />nc1# #ltpropercondition for trarisp4rtatior► accortifr to the f"ulations of the <br />Uj rtrnent oflrattspt�IttalttMeArzDan <br />�fiF <br />TATIVIE DATE <br />l�t3p 1{ tlf SCNQ C. REGISTRATION NUMRER <br />5447 <br />O NAME TEUEPHONE NLIMM <br />Shpp $ .,. �.. ,. < .. ., n .,. ;' (510) 265-0742 <br />cc ADDRW DATE MEDICAL WASTE COUICrED <br />`. a 23575 Cabot Blvd Suite 205 Hayward, CA 9432-04-2019 <br />RMW _ 5 at Counter <br />„. <br />ac 7 <br />certify that the information provided above is true and correct and that only uratreajed medical wastes are contained in this load, t am aware that <br />sification of this manifest may result in forfeiture of my porter's registration and/or the privilege of utilizing State -authorized facilities. <br />12-04-2019 <br />IEPRESENTATIVE(Print) OF REPRESENTATIVE DATE <br />THJNNUMBER <br />ry NAMEEST �,, NSPORTING OR UNLO WASTE INITIALS REGISTRATION NUMBER <br />::- <br />r <br />cr COMPANY N TELEPHONE NUMBER <br />a <br />A ; - DATE MEDICAL WASTE COLLECTED <br />1 <br />♦Wi14 orf/ rt! tC9tf[. ""NR.i lint Wf( Y6FM. wrn.# <br />�I— i certify that the i provided a rue rzect and that oniv medical w contained in this load. i am aware that <br />, <br />A!ngState-authorized facilities.. <br />� <br />ORION <br />w w <br />NAME OF COMPANY REPRESENTATIVE(Print) OF REPRESENTATIVE DAj <br />.,.. u_ <br />," <br />COMPANY NAAIE „w LEPHOI <br />s.wx_ <br />LOADED TOTAL WEIGHTDEPOSfTED/UNLOADED <br />AL <br />r� <br />zed to accept untreated medical wastes and cR' ve indicated <br />