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HAIARIlUt", MATERIAL SHIPPING DUCUM"Flime <br />IRAWSpORTEH:Stericycle, Inc. <br />4135 West Swift Ave. <br />Fresno Ca 93722 <br />(559) �75-0994 <br />24 HCUR FgLRCENCV PHONE: J-8011) 234 N61 <br />---- -- ---- <br />GENERATOR ACCOUNT It. CALIF <br />SUTTER GOULD NORTH CALIF PEDS <br />REGULATOI&V <br />SERVICE DATE: 10104/06 10:24 w AM <br />SHIPPING DOCIIMENT #: m0FR0049Y0 )9 1 PGI' <br />MLoICAL WASTE 6. U1,13t, <br />IOIAL CONTAINERS COLLECTED: 8 <br />IGIAL VOLUME COLLECTED: 47.1 EU FT <br />VOL <br />SUMMARV(gy ConjType) QTY CF <br />TB14 44 Gal Tob(Bio), 8 47.2 <br />Address and Tel <br />Ck <br />A A 'r:4 r -a <br />T814 OOA00o2 IB14 ii0AuUO3 1814 <br />1814 Oopoo5 T814 0,(JA[)0t,,6 TB14 <br />T814 OOA0008 TB14 <br />I,i_ airy LIN,. late that the cani-Is uf tl)i5 <br />u,i:�rnuant tie fully and acc­.ately <br />.31,,i,e by the PIOPe' <br />c I ass i f ied pad <br />d -d, and it' a' I <br />j,,ht,jje <br />d!j)JACar E <br />I proper condition <br />i t i on <br />lit, intem�t;"Ildl Aid <br />iu4p <br />U , applicable <br />I14tiutlal ouve(nmental regulations. <br />IN CASE OF EMERGE14CY CONTACT. CHENTREC 1-800-234-0101 MEDICAL WASTE TRACKWG FORM NUMBER : <br />ephone Number <br />DRIVE>le <br />Kid <br />oer <br />' RMATURE <br />WASTE TRANSFER DATE: L_Y__ <br />I—ITHIS IS A THROUGH SHIPMENT. <br />DESTINATION FACILITY: <br />TERICYCLE INC - FRESNO, CA <br />NORTH SAKI t UI <br />TERICYCLE INC <br />STFRICYCLE INC - SAN LEANDRO CA <br />STERICYCLE INC - VERNON E4 <br />DAIE OF RECEIPT AT <br />TREATMENT FACILITY: <br />DRIVERy DOCUMENT 0 PDFR00450 <br />TOTAL DELIVERED ITEMS: 6 <br />ITEM OTY <br />T814 44 Gal Tub(Bio), C 6 <br />relay declave Um the contents of this consignment are fully and amurately OTALS IN- <br />28. CONTAINER TYPE 2C. No, <br />2D. Volume 2E. tic. <br />Ann name, and are classified. parkaged. marked and latb ~placarded, and— <br />Collected <br />"2 <br />Delivered <br />P02 <br />S14PH Gallon Pharma Container' <br />Cu. Ft. <br />S1 �IIL� <br />S22PH "4 Gallon Pharma Container" <br />PO4 <br />409-267-8206 <br />Cu. K <br />108 <br />S32PH "8 Gallon Pharma Container" <br />)n goes here... <br />Permit#TS12g-�2 <br />Cu. Ft. <br />_q <br />Date <br />S32PHA+ "8 Gallon Pharma Container -wide" <br />SPORTER 2 ADDRESS <br />W <br />Cu. ft. <br />01 <br />Transporter <br />MNSPORTER CERTIFICATION: Racevt of medical waste as diesabed above. <br />Cu. Ft <br />— <br />Total Pherm: <br />Cu. Ft. <br />2, <br />12 <br />S14 "2 Gallon Sharps Container" <br />goes here... <br />Applicable pe"It! Numbers: <br />Cu. Ft. <br />"4 Gallon Sharps Container" <br />s4nature <br />4S22 <br />Cu. Ft. <br />S32 "a Gallon Sharps Container" <br />Cu. Ft. <br />S32A+ "8 Gallon Sharps Container -Wide" <br />Cu. Ft. <br />Transporter <br />Cu. Ft. <br />Total Bic: <br />Cu. Ft. <br />DRIVE>le <br />Kid <br />oer <br />' RMATURE <br />WASTE TRANSFER DATE: L_Y__ <br />I—ITHIS IS A THROUGH SHIPMENT. <br />DESTINATION FACILITY: <br />TERICYCLE INC - FRESNO, CA <br />NORTH SAKI t UI <br />TERICYCLE INC <br />STFRICYCLE INC - SAN LEANDRO CA <br />STERICYCLE INC - VERNON E4 <br />DAIE OF RECEIPT AT <br />TREATMENT FACILITY: <br />DRIVERy DOCUMENT 0 PDFR00450 <br />TOTAL DELIVERED ITEMS: 6 <br />ITEM OTY <br />T814 44 Gal Tub(Bio), C 6 <br />relay declave Um the contents of this consignment are fully and amurately OTALS IN- <br />Cu. Ft.1 T <br />I <br />Ann name, and are classified. parkaged. marked and latb ~placarded, and— <br />Chamber Incinerator <br />n far trampart according %o applicable intemat6ortal and national go"mim. ental regulators,"K3 <br />7501 State Hw 65 <br />S1 �IIL� <br />Anahuac, TX 77514 <br />Phone <br />409-267-8206 <br />ApNumbers- <br />plicable PermA <br />Permit # MSW2239A <br />)n goes here... <br />Permit#TS12g-�2 <br />19N: Rece�tot of mescal waste as dewbed a <br />,,� l,k-.J —Signalure- Odd <br />_q <br />Date <br />SPORTER 2 ADDRESS <br />Phone I <br />on goes here... <br />Apoicable PeanitNurnbers: <br />MNSPORTER CERTIFICATION: Racevt of medical waste as diesabed above. <br />Signature <br />Date <br />PORTER 3 ADDRESS: <br />0_i ne <br />goes here... <br />Applicable pe"It! Numbers: <br />ANSPORTER CERTIFICATION: Receipt of mecizal waste as described above <br />s4nature <br />Date <br />Alternate Facility <br />8C. Alternate Facility, E] go. Alfiettate Famility: <br />TStericycle, Inc. <br />Chamber Incinerator <br />4135 W. Swift Ave <br />7501 State Hw 65 <br />Fresno, CA 93792 <br />Anahuac, TX 77514 <br />559-275-0994 <br />409-267-8206 <br />MWTS/OST <br />Permit # MSW2239A <br />Permit#TS12g-�2 <br />I have been authorized by e applicable state agency to accept untreated medical viestes and that I have <br />n accordance with the requirement outlined in that authorization. <br />Date <br />MARGINAL WORD'S <br />