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HA rYll�t'` MAIERIAL SHIPPING t'IICuMENI <br />TRANS'KIR!ER Stecicycle, Inc - <br />4135 West Swift Ave. <br />Fresno, Ca 93722 <br />( 559) 275-0994 <br />a <br />b011 i MN'laCY PHONE: 1-801 <br />RNLRAIltt ACCOUNT t: 6070300-001 <br />Suttee Gould North Calif Peds <br />2505 W Hainer Lane C <br />Stockton A 95209 <br />(209) 944-4360 <br />SERVICE DATE 10118106 07:10:00 PM <br />SH i PP i Nfi DOCUMENT q : 140FRO04COL <br />HttiUTAIL1 MEDICAL WASTE 6, 2, UN3291, PGII <br />fUTAL CONTAINERS COLLECTED: 4 <br />MAL UUl_UML COLLECTED: 23,6 CU FT <br />VOL <br />SUMMARY(By ContType) QTY CF <br />TB14 44 Gal Tub(Bio), 4 23.6 <br />ouAMP M14 00A060Q TBA O(IAuo1C TB14 <br />OOAOoOR T814 <br />I <br />® <br />NFEEl]CAL W STE TRACKING FORM NUMBER <br />IN CASE OF EMERGENCY C NTA T: ^VEXTREC 1400-234-0 i 0 <br />I <br />Wdressnd Telephone Number <br />1C.), c�0 <br />I <br />13,twER.g ow, Rteasrnnrccrr# 1 <br />2B. CONTAINER TYPE 2C. No. 2D. Volume I2E. po. <br />Collected llelivered 1 <br />fpm S14PH "2 Gallon Pharma Container" � Cu. Ft. C, I <br />lie cGy dr 1.:re that the content% <br />.unsiUnu,ent ale fully and accuielely <br />il;ed auuv2 by the proper ,hippinO <br />ei ,iul „ r classified, paste •,,i. ;,,.; k,•d <br />and label let] 1placarded, and are ;n J! <br />"'op( -.1 condition tui tiaiishw, <br />anrliny t,. epl,l icahle intewat;o-1 wnd <br />,rational goveuuaenta' eyul•ations. <br />GENERATOR AGENT PRINT NAME <br />AUTHORIZED SIGNATURE <br />DRIVE Sal-ido en <br />X� <br />DRIVER ESIGNATURE <br />)PO4 S22PH "4 Gallon Pharma Container" <br />P08 S32PH "8 Gallon Pharma Container" <br />8W S32PHA+ "8 Gallon Pharma Container -wide" <br />P01 Transporter <br />Total Pharm: <br />IO2 102 S14 "2 Gallon Sharps Container" <br />0' <br />04 S22 "4 Gallon Sharps Container" <br />�8S32 "S Gallon Sharps Container" <br />2- S32A+ I'S Gallon Sharps Container -Wide" <br />W <br />Transporter <br />Total Bio <br />Nereby declare that the o of this consignment are €udy and a=uraiety OTT ALS 011 <br />pira name. and are cl- i . marked and t�zeNedlptacarded, a <br />lion far transport accord irrWnlatiin� and national goveraraaental regLdations." <br />a <br />ition goes here... <br />%TIOM: Receipt of nedical wase as <br />,��'✓ Signitur <br />htJ PCIP'at'R 2 ADDRESS <br />Cu. Ft. <br />i 0 <br />Cu. Ft. <br />IS A THROUGH SHIPMENT. <br />Cu. Ft. <br />I <br />I 0 <br />Cu. Ft. <br />4135 W. Swift Ave <br />Cu. Ft. <br />Signature <br />Date <br />i <br />0 <br />Cu. Ft. <br />enc #.: <br />Cu. Ft. <br />I <br />Aopilcabie Permd Numbers: <br />I 0 <br />Cu. Ft. <br />Cu. Ft. <br />Srgnatrse <br />Cu. Ft. <br />C) <br />Cu. Ft. <br />r <br />Pune *: <br />Applicable ftim Numbers: <br />Date <br />Phone <br />M <br />iation goes here... <br />Appiirsbte Pentad Numbers. <br />t <br />IS A THROUGH SHIPMENT. <br />Stericycle, Inc. <br />r L 1 <br />TRANSPORTER CERTIFICATION: R eue�d or medical wase as dewed above. <br />4135 W. Swift Ave <br />I <br />Signature <br />Date <br />r <br />µ 4 n 3 ADDIRESS: <br />enc #.: <br />t 0 <br />ere... <br />Aopilcabie Permd Numbers: <br />I <br />PORTER CERTIFICATION.' Receipt of mecuat waste as deser d above. <br />I <br />j 0 <br />Srgnatrse <br />Date <br />I <br />I <br />' WASTE TRANSFER DATE: 1 _ t —_- <br />a®. AEterraate Facility: <br />gG. Atternafe Farlity: 8D. Adtevnate Facility.' <br />IS A THROUGH SHIPMENT. <br />Stericycle, Inc. <br />Chamber Incinerator <br />I_ITNIS <br />4135 W. Swift Ave <br />7501 State Hw 65 <br />DESTINATION FACILITY: <br />Fresno, CA 93792 <br />Anahuac, TX 77514 <br />559-275-0994 <br />409-267-8206 <br />a _ STERICYCLE INC - FRESNO, CA <br />I I_STERICYCLE INC - NORTH SALT L, Uf <br />MWTS/OST <br />Permit # MSW2239A <br />-_ - ,ur -Clyy LEANURQ CA Permit#TSJO�'�' 22 <br />�, TREATM l roia.rLr ,.. __. _ nat I have been authoinzecFtxy the applicable state agency to accept untreated medical wastes and that I have <br />i1C received the above indicated wastes in accordance with the requirement outlined in that authorizzation. <br />I Printlype Alan;e <br />Sig>nat:xe <br />Daae <br />I <br />0 I <br />=ME'.Ill4= <br />n <br />I 0 <br />I <br />I01 <br />I <br />I <br />1 <br />I 0 <br />I <br />i0i <br />I <br />I <br />I <br />I 0 <br />1 Lf <br />