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Superior Medical Waste <br />Superior Medical Waste, Inc. 267/269 S. Arrowhead Ave. CA <br />5MP TO San Bernardino, CA 92480 <br />Tracking Document (800) 973-4430 Traddng # <br />Transporter Permit # 6324 CDC229 <br />Transfer Station Permit # 123 <br />EPA# CAL000401279 <br />Generator Information <br />Name: Califamb Heafth Cafefaicility Site #: C"CF <br />Address: 7707 S. Austin Roid . Telephone: 200,4674657 <br />City:3tsabittaR State* CAI Zip: 015215 Route: Hasioa <br />UN3291, Regulated Medical Waste, n.o.s., 6.2, PG 11 <br />From Customer <br />Container Qty. Weight <br />za <br />za <br />38 <br />40 <br />44 <br />96 <br />SM -TOTAL <br />Container <br />Signatures For Compliance and Authorizations <br />I ;;;;rw declaremat the —tmt0lV'i' mnN9nment arc iuly and atwretely descrNeA above tri Proper 0.r IN, wMem of —0 il Iftel ka.16— Id —V Total Containers: <br />5hoolot "'"and am"Orwil,packed. PmA*d and kibe#ed. w4 are M ag~rs jopmpert�*ftfffi- L -y V* US Code .1. " RIVdk— W1. Total Gross Weight: <br />tar �Wchrll to *PokatIN 93"mment rcruletiom and Depwt�t of Tainse, on, F:-.;W.W4U StAII W.."d P"'Aftm Minus Tate Weight: <br />k <br />T <br />JNet Lbs: L, Li <br />Aomer Name: & <br />9Aajk)'7(4—ej Customer Signature: Da 1w /7, /7 <br />'PLW Print FULL Name) ease Sign FUL• L <br />Route Driver:. Route Driver Signature,: Date: <br />(Please Print FULL Name) (Ple;1011in FULL Name) <br />Certificate of Receipt: Cenificati011 Of receipt of wage as covered by this tracking document number. Healthwise Services, 4800 E. Lincoln Ave., Fowler, CA 93625 <br />Transfer Driver: -,!2k- Transfer Driver Signature: Date: <br />Print FULL <br />FULL Name) <br />Contact Information <br />24 HOUR EMERGENCY PHONE: <br />Support provided by Chemtrec <br />1-800-424-9300 <br />to C"*"W - C)OM CO"WrAn <br />14—�" <br />��WCS76�1'p4 <br />Commerft, or Dhorepandes <br />Certificate at Receipt: <br />of wot covered by this tracking document number. <br />IRM1111111M. <br />1111111IM1111 <br />K.71V J N LW <br />0 L, I "10 <br />f-71—n—ow 0'tMl -9�Z <br />Coruscate of 00swuction: Cefification of de wuct�1`91 <br />waste as covered by this tracking document number. <br />M"KhVAM services, 4=0 1. unvoin Ave, 93M T: S",B34-3333 TS -99 <br />Signature: <br />I <br />Date: Transporter Permit 06070 <br />3*51liplatedfaclift <br />Aftmate Deftustalli Fed9ty <br />Signatures For Compliance and Authorizations <br />I ;;;;rw declaremat the —tmt0lV'i' mnN9nment arc iuly and atwretely descrNeA above tri Proper 0.r IN, wMem of —0 il Iftel ka.16— Id —V Total Containers: <br />5hoolot "'"and am"Orwil,packed. PmA*d and kibe#ed. w4 are M ag~rs jopmpert�*ftfffi- L -y V* US Code .1. " RIVdk— W1. Total Gross Weight: <br />tar �Wchrll to *PokatIN 93"mment rcruletiom and Depwt�t of Tainse, on, F:-.;W.W4U StAII W.."d P"'Aftm Minus Tate Weight: <br />k <br />T <br />JNet Lbs: L, Li <br />Aomer Name: & <br />9Aajk)'7(4—ej Customer Signature: Da 1w /7, /7 <br />'PLW Print FULL Name) ease Sign FUL• L <br />Route Driver:. Route Driver Signature,: Date: <br />(Please Print FULL Name) (Ple;1011in FULL Name) <br />Certificate of Receipt: Cenificati011 Of receipt of wage as covered by this tracking document number. Healthwise Services, 4800 E. Lincoln Ave., Fowler, CA 93625 <br />Transfer Driver: -,!2k- Transfer Driver Signature: Date: <br />Print FULL <br />FULL Name) <br />Contact Information <br />24 HOUR EMERGENCY PHONE: <br />Support provided by Chemtrec <br />1-800-424-9300 <br />to C"*"W - C)OM CO"WrAn <br />14—�" <br />��WCS76�1'p4 <br />Commerft, or Dhorepandes <br />Certificate at Receipt: <br />of wot covered by this tracking document number. <br />TS -W <br />Signature: <br />. _'.. 6��lpt <br />Adm <br />7 <br />f-71—n—ow 0'tMl -9�Z <br />Coruscate of 00swuction: Cefification of de wuct�1`91 <br />waste as covered by this tracking document number. <br />M"KhVAM services, 4=0 1. unvoin Ave, 93M T: S",B34-3333 TS -99 <br />Signature: <br />I <br />Date: Transporter Permit 06070 <br />3*51liplatedfaclift <br />Aftmate Deftustalli Fed9ty <br />Aftemate Desta—d Facliky <br />AkwrA% DedVwW fad*V <br />Alternate Dedpated Featil, <br />Aftemate Designated <br />FwWtV <br />Aftaeflaw Mdvwftd Fod9w <br />Afternato DeApated Fad4ty <br />kqMrW WOW Wast*, Inr <br />heaftwise Seo*e' LLC <br />national Green bas, LLC <br />t67/269 S. Arrowtwad Ave. <br />400 L Uncoln Ave. <br />$2479 Atoning Way, &jft F <br />;W Bernardino, CA 92409 <br />fowler, CA 93625, <br />ludo, CA 92201 <br />OMS73-4430 <br />") L3a-3333 <br />(760)347-4422 <br />%M* 9 U3 <br />P*Mft # TS -99 <br />Pe"l* 9 Ts--OST-99 <br />'J'ansporter Pe"Mitz 6324 <br />Tardporter Permit: 6070 <br />