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Superior Waste <br />Medica <br />Superior Medical Waste, 1 n C. 267/269 S ArrowIhead Ave. CA <br />�LS`fE n San Hemarfino, CA 92480 <br />MOO <br />Tracking Document (800)973.4430 Tmcidng# <br />Transporter Permit # 6324 <br />Transfer Station Permit # 123 CDCIS9 <br />EPA# CAL000401279 <br />Generator Information Contact Information <br />Name: CaRfvnria Health Care Fac&V Site # CHCF 24 HOUR EMERGENCY PHONE: <br />4ddress: 7707 S. Austin Road Telephone: A19-467_4657 Support provided by Chemtrec <br />City: Q*#W t"IM State: re Zip: CK71r. Route: _ __Aceyjm 7 14MO-424-9300 <br />• . .ed Up from Customer <br />M -: i <br />UN3291, Regulated Medical Waste, n.o.s., 5.2, PG 11 <br />iign;l,fes For Compliance and Authorizations <br />raydabtatNet9�etmmmt'aiiedeomeare PoeyaW aoaue4ydasal6ed aLora br+mm� <br />lm-10mdmdOsg%d.r nvdmdwWk*AdWvderetnae=pKftInpmpweondma. <br />Cid_ If.r` <br />Customer Name: <br />• Route Driver. <br />warowcuu.rn eorw.smer.oar .�amemmr Total Containers: q <br />aa.edere.klasbaoarede<ra�t.uwuany« Total Gross Weight: <br />"Nbrrsme FAIN WNftwell— j Mlnus Tare Weight: <br />L T Lbs: — <br />Customer Signature: Date: <br />(Please Ste Rn4L time) <br />Route Driver Signature: <br />(Please Prim FULL Name) IF <br />:eMcate of RewlpC cartfficatfon of recelpt of waste as covered by this tracking document number. <br />Transfer Driver: !� Transfer Driver Signature: <br />(PI—PdMjll0ame) <br />R)4N—) - - <br />mise $ervfces, 4800 L Uncoln Ave., Fowler, CA 93625 <br />Date: <br />commerst4 or O rrdat <br />:erifftce a of Receipt: of waste as covered by this tracking document number. -AI23 01 <br />signature: <br />Certllicate o/ Destruction: Ceriflcation. destructbrr of waste as covered by this traddng document number. riaanhwbe se,rrces. aeon E unaohk Ave, t �7T!s49�` <br />;%nature: Date: Transporter Penna 86070 <br />?asfpwtedFae0lly <br />AMerrksoeoedgnamaFeilFeemty <br />AlternateDeftmetedFedRyAfter <br />ts.steMWFeditty <br />ARarr�eee Fadtlty <br />Ahemateoe ditdit <br />AtcarrwaeDashedFacey <br />w wt Me W woete. ikke <br />Heattlwrbesks•Aca u;G <br />National Gr n G:u. LLC <br />!67/2645 NW*I sad Are. <br />48M E uucoln Ave. <br />82-M Fderrdoe Way, 5o8e F <br />len 8erkardino. CA924De <br />Fa ler. CA93R5 <br />InkAq CA MW <br />Sam 973i490 <br />ice) a44-i3;i <br />(I) 3474422 <br />W"XI23 <br />PermItMa9 <br />PamdtaTS-967-94 <br />'rampoftvPamkC 6324 <br />—nsP-rterPamlk6G/0 <br />