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. ' s <br />CALIFORNIA MEDICAL WASTE TRACKING <br />TRACKING # <br />=® sers�rz4rrrn <br />WASTE TYPE: <br />All Chemical DISpO&QI, Inc. <br />21 GREAT OAKS S -VD., SAN JOSE, CA 95119 <br />PHONE (408) 363--'1660,/, FAX (408) 363-3587 <br />HAULER PERMIT # 2914 <br />r�nk1TA1n1cD nn MADCOc Anrn AtITI 1A1 1A1c1t--u-r. <br />. FACILITY <br />- <br />- - -- - <br />- - - - - <br />PHARM. <br />CONFIDENTIAL <br />r <br />BIO/SHARPS- <br />PATH <br />CHEMO <br />ANIMAL <br />WASTE <br />RECORDS <br />OTHER <br />LBS. <br />TOTAL CONTAINERS PICKED UP: <br />LBS. <br />r�nk1TA1n1cD nn MADCOc Anrn AtITI 1A1 1A1c1t--u-r. <br />. FACILITY <br />- <br />- - -- - <br />- - - - - <br />r <br />LBS. <br />LBS. <br />LBS. <br />LBS. <br />S <br />PHONE : <br />SERVICE ADDRESS: <br />LBS. <br />LBS. <br />LBS. <br />LBS. <br />LBS. <br />CITY: <br />STATE: <br />ZIP: <br />CA <br />N E <br />r_ V. ,,.. <br />LBS. <br />LBS. <br />LBS. <br />LBS. <br />LBS. <br />TRANSFER STATION: [ I SANITEC USA PERMIT# TS/OST20' <br />9065 NORRIS AVE. <br />ALL CHEMICAL SUNVALLEY, CA 91352 <br />DISPOSAL INC. (818) 504-0343 ARRIVED: <br />LBS. <br />LBS, <br />LBS. <br />LBS. <br />LBS, <br />21 GREAT OAKS BLVD., [ .`SANITEC USA, PERMIT# TS45 <br />SAN JOSE; CA 95119 2900 APRON AVE., BLDG 1690 <br />PERMIT # TS -35 ATWATER, CA 95301 <br />(209) 388-0285 <br />LBS. <br />LBS. <br />LBS. <br />LBS. <br />LBS. <br />DATE ARRIVED: ARRIVED: <br />ACCEPTING WASTE <br />LBS. <br />LBS. <br />- LBS. <br />LBS. <br />, <br />TREATMENT: <br />EST. TOTAL WEIGHT: <br />WEIGHMASTER LOG NUMBER AND <br />{ I SANITEC USA ` <br />( I CLEAN HARBORS <br />( I WASATCH <br />9065 NORRIS.AVE. <br />11600,N; APTU:S ROAD <br />650 E. HWY. 193 <br />INITIALS OF DEPUTY <br />SUN.VALLEY, CA 91352 <br />ARAGONITE, UT 84029 <br />LAYTON, UT <br />(818) 504-0343 <br />(801) 323-8100 <br />(801) 771-3032 <br />ACTUAL TOTAL WEIGHT: <br />'SHREDDING! <br />1NGWERATiON <br />PHARMACEUTICAL <br />AS A REPRESENTATIVE OF THE ABOVE' FACILITY, I CERTIFY THAT THE CONTENTS <br />MICROWAVE <br />PERMIT#. <br />INCINERATION <br />PERMIT # TS/OST 20 <br />UTD98`1552177 <br />PERMIT # 1100033001 <br />DESCRIBED ABOVE, ARE PACKAGED IN ACCORDANCE WITH THE STATE OF CALIFORNIA <br />REGULATIONS, AND HAVE BEEN COLLECTED AND REMOVED. <br />DATE RECEIVED FOR TREATMENT: <br />FACILITY REP: ., ..u. <br />DATE: <br />'N-kGNATURE ` <br />SIGNATURE OF AUTHORIZED ALL CHEM REPRESENTATIVE: <br />r H <br />X �. DATE: m. - <br />