Laserfiche WebLink
0pa StericyCle` <br />s notedralPeople. RosidollRisk: <br />MEDICAL WASTE TRACKING FORM NUMBER <br />GSE OF EMERGENCY CONTACT: CHEMTREC 1-800-424-0 STANDARD MANIFEST 001.10.06 -STD <br />Route #: 132 - 2 CUSTOMER NO. 21132 MOFROOJZNI <br />1. Generator's Name, Address and Telephone Number 1 <br />ATTN: John Menaugn <br />DOCTMS HOSPITM or MATMCA <br />1205 E NCFRTH ST <br />MANTECA, CA 95336— 4932 <br />(209) 823-3111 <br />CUSTOMER NUMBER 6018849-002 GENERATOR'S REGISTRATION # <br />2A. DF-SCRIPT16N OF WASTE 26• CONTAINERTYPE 2C. NO. OF <br />6 23291 Regulated.Medical Waste, n.o.s., TBOS — 40 Gal Tub (Bio) (S.3 cu- ft) CONTAINERS <br />URegulated Medical Waste, n.o.s., <br />6.22,,PG1b. TB49 — 37 Gdl Tub (Bio) (4.9 Cu ft) <br />CC PGie' <br />0 6 2, PGII Regulated Medical Waste, n.o.s„ THl4 _ 44 Gal Tub (Bio) (5. 9 Cu ft) L� <br />Q UN3291Regulated Medical Waste, n.o.s., T821— (BIO) /TP15— (gads) JTY15— (Chemo) gra gal Tub (2.7CUFT) <br />X 6.2, PGII <br />ELFZ 6.2, PG UN3291 Regulated Medical Waste, n.o.s., WB31— (Ri.o)1WP31— (Pact') /VC31— (Chemo) 31 Gal Tub (A.14CUFT <br />W <br />6232PGII'ReguiatadMedlcaiWaste,n.o.s., t n&2—(gra)ILmd3—(Fath)/ 3—(chemo) Gal Tub(5.7CUFT) <br />UN3291 Regulated Medical Waste, n.o.s., <br />6.2. PGII' KRB — Biosystew Cardboard Box (4.2 cu ft) <br />UN3291 Regulated Medical Wasto, n.o.s., <br />6.2, PGiI <br />G 23229i Regulated Medical Waste, n.o.s., <br />3. Generator's Certification: 11 hereby declare that the contents of this consignment are fully and accurately TOTALS <br />described above by the proper shipping name, and are classified, packaged, marked and labelled/placarded, and —� <br />aero inn all respects In proper conn itfon tot nsport accoTdtrtg to applicable international and national governmental <br />12/iit2131? <br />2D. VOLUME <br />'Z . `} <br />Owl <br />a <br />a. TRANSPORTER 1 AD1 RESS: <br />St:eteiCycle, Ina. This s is a Thr <br />Phone #: (866) 783-7422 <br />Appiicable Permit Numbers: <br />x <br />4135 iQ. Swift Ave <br />Hauler Reg# 3404 <br />Frianno, CA. 93772 <br />a a <br />TRANSPORTER CE FICATION: Receipt of medical waste as described above. <br />PdntrypeName ti Signatu <br />Date <br />6. INTERMEDIATE 4ANDLEIT2/TRANSP RTER 2 ADDRESS: <br />Phone #: <br />Ug <br />Applicable Permit Numbers: <br />0.a <br />INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Receipt of'medical waste as described above. <br />PrInMpe Name Signature <br />Date <br />M <br />1hApplicable <br />6. INTERMEDIATE HANDLER 3 /TRANSPORTER 3 ADDRESS: <br />Phone #: <br />Permit Numbers: <br />INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Receipt of medical waste as described above. <br />Print%pe Name Signature <br />Date <br />7. DISCAEpANCY INDICATION <br />z <br />w <br />Q <br />Lu <br />Dealtinatod FacTlity: !4j 1 Ba. Alternate Facility: L j 80. Altarnato Facility: Li 8D. Alternate Faciffty: <br />SWrIcycle, inc, ME WE O 7 Staricyde, Inc. Stedcycle. Inc. <br />4135;Z SWH! W 8t3 N. FOXbOrd Draw 1551 Shafton Dd" <br />l=rosno,t^.A 937 North Salt Llalae, UT 840 Hollister, CA 950223 <br />(��� 422 EC 1121117 (8W7s3-7a2 `86,)703-7422 <br />3A--448-JA-36 TS/OST 83 <br />received the d <br />V <br />Print/'lype Name <br />FACILI' TY: I certify tits t hav been authorizecl'by the applicable state agency to accept untreateda nvy-mr-%Bove Indicated wastes In accordance with the requirement outlined in that authorization. <br />I <br />. signature "!Tik oats <br />Transferred, tronta tan rs. , 1 cI ttto ccs , ,. 111117 <br />JACQUE WILSON <br />