Laserfiche WebLink
Superior Medical Waste, Inc. <br />Superior Medical Waste <br />267/2695. Arrowhead Ave. <br />CA <br />San Bernardino,f�492480 <br />Tracking Document <br />(800)973-4430 <br />Tracking# <br />Transporter Permit # 6324 <br />COC261 <br />Transfer Station Permit # 123 <br />EPA# CALOOM1279 <br />Generator Information <br />Contact Information <br />Name: Cafifartria Health Care facd ty Site # <br />CHU <br />24 HOUR EMERGENCY PHONE: <br />Address: 7707 & Austin Road Telephone: <br />209_467746S7 <br />Support provided by Chemtrec <br />City: Stprkton State: CA Tip: 9521S Route: <br />FiegsigIn 2 <br />1-800-424.9300 <br />OaBtrefad to Cwtonw - Ciew Containers <br />UN3291, Regulated Medica! Waste, <br />n.o.s., 6.2, PG 11 <br />ked Up From Customer <br />Container qty. Weight Container City. Weight Container City. Weight <br />Container City. Weight <br />Container. Qty. Weigt <br />20 <br />20 <br />28 <br />28 <br />38 <br />38 <br />40 <br />40 <br />44 <br />41 <br />96 <br />96 <br />SUS -TOTAL SUB-TOTAi. SUR -TOTAL <br />SUB -TOTAL <br />SUB-TCRAI <br />Notes, f;Ammarnta, W au••pencies <br />Signatures For Compliance and Authorizations <br />1 dj <br />{ herby dwetan that thw—lent of till ten iP~t m WRY and tca N dwutibwd show byPopp tfinthwred—ftt Oft 04—t of ~1 k sae d h..d.uoa:^.d rtrwrwnr Total Containers: <br />( t <br />M <br />.Mtwin(rwmo ar!C lac W.XvtJ.o-W,..A0 and l+bekd, and are in aNaapr:.ctw M�w.uer <undhnon warts asdeed Mthe tb toaw of redw+anwyyypwa and/a Total Weight; <br />lortranwpott=wdmm <br />krt to avpk4bl,17 trrg.Wtions and oeparttnent of Trantportahon.,andf" aaMopnW state Rled uwnd Res"— <br />Minus Tare Weight. <br />T- et Lbs: <br />ski <br />,tomer Name: l Chi^ 1 Customer Signature: <br />Date: <br />(POA Print FULL Name) (Please Sign FULL Na4rne) <br />Route Driver;. _ _ Route Driver Signature: _. Date ' a <° <br />/;// <br />(Please Print FULL Name) <br />(Please FULL nee) <br />Certificate of Receipt Certification of receipt of waste as Covered by this tracking document number. <br />althwise Services, 4800 E. <br />Lincoln Ave., Fowler, CA 93625 <br />Transfer Driver: Transfer Driver Signature: <br />Date: <br />(Please Print FULL Pe <br />(Please Sips FULL Name) <br />Cartlnrate of R6eeipt Certification waste as covered by this tracking document number. <br />�1 <br />a q <br />fN � TS -123 <br />Signature: <br />ate: ✓�� <br />Certificate of DeanaYfon: Cerification Of dZ n ofIn;adtowelby this tracking document number. <br />Healthwtse Sendtxs, <br />4800 E. Unto. Aw., CA 93625 T: 558 i34 3333 TS -99 <br />Signature: <br />- <br />Date:— Transporter Permit room <br />Ogiatated Facility <br />ARemate Desiptatad Fad ft <br />Akotnate Oestptagd FedW <br />Alternate Daynated Fadft <br />Aitertta» Desi <br />hart" FosdW <br />Alternate Deeks ted F*Mty <br />Nombe Dedpated Fad1LLy <br />Akatrtate Des sated FodDttt <br />kworbrt ei"wasta, au. <br />Heakhwlfe Service, LLC <br />Na tonal Green Gas, LLC <br />257AWS. Mowhead Aye. <br />4800 E. Unonhn Ave. <br />82.579 PA rima Wey. Suite F <br />Sia Demardino, CA 92408 <br />Fowler, CA 93625Indio, <br />CA 92201 <br />WM 0734M <br />(569) 834-3333 <br />(760) 347.4122 <br />4,111111t Jr 123 <br />Penmk S TS -89 <br />permit # TS-osTA9 <br />mft: <br />Transporter Par6324 <br />1Tansprter Permit: 6070 <br />