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Superior Medical Waste, Inc. <br />Superior Medical Waste <br />267/269 S. Arrowhead Ave. <br />CA <br />ayffajlR�San <br />Bernardino, CA 92480 <br />Tracking Document <br />rans9oterPa <br />Traddrig# <br />Transporter <br />Transporter Permit # 6334 <br />r 2 <br />r_i7`�,c6I <br />Transfer Station Permit # 123 <br />EPA# CALWM1279 <br />Generator Information <br />Contact Information <br />Name- Cali1'orria, Hrgakh Care Facility Site #: C;4r-F <br />24 HOUR EMERGENCY PHONE: <br />Address: 1,1707 S. Aurthl Road Telephone: 209-467-4657 <br />Support provided byChemtrec <br />City: -. State: Zi 2 Route: qaginr, 2 <br />1-800-424-9300 <br />- <br />Deaver" M0111tolw- clew conowArs <br />UN3291, Regulated Medical Waste, n.o.s., 6.2, PG ll <br />U From Customer <br />!ked <br />tainer ory. Weight Container Qty. WOW contairn Weight Container Qty. Weight Container Qty. Weight <br />30 20 <br />28 28 <br />SB <br />40 40 <br />W 44 <br />96 ga <br />[SU8-TOTAL <br />SUBTOTAL SUS-TOTAL77F77 SUB-TOTAL SUR-TOTAL <br />Notes, comments, or Olsorepandes <br />Signatures for Compliance and Authorizations * J <br />I ewebw dadara that ther. Wtof BtintohlonwVt are fuay and auvrately deu W anew by peop.rr„ denu.u„rvu,rtam..uoswa:c,pr r.a�anrd..,sandm..a,ry Total Containers:_ <br />9*vi" name and arc 0—ifted, pad�ed, mv*W and 1*1,0 , and are in all aspects In proper mx$ffl n wanes as,entad by 0. US 0. fa of Fed—, PeeuWrons and Total Gross Weight: <br />for transport aaordinii to applicable go AMA t ralotrbw 40 Department of tQW.0 "00n. .0—pta"nata state fides and MgNtlom. Minus Tare Weight. --` <br />Total Net s: "— <br />Aomer Name: Customer Signature: Date: <br />�Zjj <br />Print FULL Namel (Pie Sign FULL Na <br />Route Driver. Route Driver Signature: I.r__Date.. <br />_ ... <br />(Please Print FULL Name) (Please n FULL Name) <br />certificate of Receipt: Certification of receipt of waste as covered by this tracking document number. hwise Services, 49M E. Lincoln Ave., Fowler, CA 93625 <br />Transfer Driver: Transfer Driver Signature: Date: <br />(Please Print FULL Name) (Please Sign FULL Name) <br />Certificate of Receipt: Ion aipt a as covered by this tracking document number. T: i <br />Signature: t / Date: <br />Certlfiate of Destructba: Cerification of destruction of waste a5 Covered by this tracking document number. H"IUWA a Servkes.4800 e. uncdn ave, ca 93615 T: 3333 TS 89 <br />Signature: Date: `h�VL �VJ Transporter Parndt0070 <br />-- <br />oesWwted F-01ty <br />Aitn"M Designated Fat*Ay <br />Akerns" -ft-ted Facility <br />D-W- W Fatlaty <br />MW-ft DesipgLed Facility <br />Altercate 0-1ill ate8 F- ty <br />Ntemate ftftww FaWity <br />Murnata Oesign—d FacMy <br />swdor Medical waste. Irtc <br />Nrawmiso Service, LLC <br />Nam"Green Gas. LLc <br />267/269 S. Atrr~ Ave. <br />49W a Ut=Mf Aw. <br />Br579 Reining way, Suite F <br />Son Bertwtlln%CA 32408 <br />Fowler, CA 93625 <br />Ira#o, CA 92201 <br />MM 9734830 <br />(5581814-a333 <br />(760)3474422 <br />Perm*0123 <br />Pe"rAVTS89 <br />Pem*#TS-OST•99 <br />Transpa'( r Parmn: 6333 <br />arttporter P. 6070 <br />