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0 <br />0 <br />Superior Medical Waste <br />-'W Superior Medical Waste, Inc. 267,269 S. Arrowhead Ave. CA <br />San Bernardino, CA 92480 <br />Tracking Document Tranransporterrter o.30 Permit # 6324 Traddng# <br />Transfer Station Permit# 123 CDC_196 <br />EPA# CAL00O4O1279 <br />ienerator Information Contact Information <br />lame: Calffonria Heath (Care Facility Site #: CHEF 24 HOUR EMERGENCY PHONE: <br />address: 7707 S. Austin Road Telephone: 209_467_4657 Support provided by Chemtrec <br />:ity: StrtrkIna State: CA Zip: Route: 1-800-424-9300 <br />n.aa.....r r,. nw.,...._ n..« r...s. <br />From Customer <br />UN3291, Regulated Medical Waste, n.o.s., 6.2, PG li <br />ignatures For Compliance and Authorizations <br />,erebydedere duttbecontentofdds owalyMMdarae@yaml aconat*dawrewd abweby prIXtm tRadar decbm tat" Wmaeneofaaimhheefhcardm and mscwy <br />Wing name and asedasdFK padtad.=rW and Isbaled,and aro In al wpeM In PMW andWon wrutara Minot by tha05 Code ofFadad Rgtdatlmu ad/o <br />w bwupwt vownilne to spalloWe aanmanan regukadons and Deparunam N•hanspmmtlon. ead/at apryaprWeSute wdasartl ttegaeastn <br />Customer Name: Ili► �, {�j Customer Signature: ac <br />PdntFULL <br />Route Driver Route Driver Signature: <br />(PieL PTWFULL Name) (Plea! <br />ertiticate of Receipt: Certification of receipt of waste as Bred by this tracking document number. <br />Transfer Driver. Transfer Driver Signature: <br />Tota) Containers: <br />Total Gross Weight: <br />MlnusTareWeigM:„ <br />FULL <br />Date: <br />Date: (T <br />Jncoln Ave., Fowler, CA 93625 <br />Date: <br />Comments, or Dkaainindes <br />ertifikate of Receipt: Ce of receipt of waste as a vered by this tracking document number. Ode T5 -123 <br />ignature: iV �PM�I t /rj`L/"� <br />:ertiRrate of Destruction: CeHfip destruction of waste as covered by Oils tracking document number. HatMNse Servat% 4900 E. unoln Ave., Fowl u 93625 r. 3 TS 49 <br />Bnature, Date: Transporter Permit 46070 <br />0skm tad Far9{ty <br />Alterrtede Deslipualed Facility <br />ADarnate Desknoted FacMty <br />Attar— DasW--d -dMy <br />Afteraata Derllpnated Favi ty <br />Altermte DadpWW Facility <br />Alternme Dadipnated FadBW <br />ARemate Desifpnted Facility <br />rparlor�Me I wane. Inc <br />HealtlnMse Sento, LLC <br />National Gree Ws, LLC <br />7/2695.Anowhead Ave. <br />43M E. Lknoln Ave. <br />82-579PWn t4Way,SvlteF <br />m eanwrdlno. CA 92408 <br />rwwe , CA 93625 <br />Indo, CA 92201 <br />(10) 973.4430 <br />059) 6343333 <br />RM) 3474422 <br />trnrit0123 <br />POWANIS-89 <br />Pamk47S-M-99 <br />artspwta PennM 6324 <br />Tansporoer Permit: 6070 <br />