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�''�'1 Superior <br />Medical Waste, <br />Inc. <br />Superior Medical Waste <br />267/269 S. Arrowhead Ave. <br />CA <br />M6 <br />Alternate Dadp+eted FadCty <br />Aitamate Dmynsted Fad fry <br />San Bernardino, 0 92480 <br />Nealthv s ser U.0 <br />Tracking <br />Document <br />(800)973-4430 <br /># 6324 <br />Tradttng # <br />267/269 S. Artaabead Ave. <br />48M E Untabe Ave. <br />Transporter Permit <br />t fjC 121 <br />Transfer Station Permit # 123 <br />San 8eoardhw, CA92408 <br />F*vA-, CA 936]5 <br />kKW CA921o1 <br />EPA# CAL000401279 <br />Generator information <br />(800)9734030 <br />(559)834-3333 <br />(760)347.4422 <br />Contact Information <br />Name: Ca)ifonria Health Care Facility <br />Site M <br />CHCF <br />24 HOUR EMERGENCY PHONE: <br />Address: 7707 S. Austin Road <br />Pena88TS-W-99 <br />Telephone: 209_467_4657 <br />Support provided by Chemtrec <br />City: Stocktnn State: <br />C7A Zip: <br />Route: <br />Reeion 2 <br />14WO-4249300 <br />oelim tocultaraer-Clem conatmm <br />0 nicked Up From Customer <br />container <br />UN3291, Regulated Medical Waste, n.o.s., 6.2, PG 11 <br />Signatures For Compliance and Authorizations 1 <br />ilw� d�e+tieeaemmr„torwcmnnevnsMe faftvwiaoaws"de—UmdabmbVP- er jjftd-dd—tWvftwaamaor.au.ar..ana>orcim.ndmmmn Total Co Containers., j <br />shfivim none and am dasdHed, padrod, madded ad labeled. OW era to dlmpeds N props mmditlon +.e0. m dorsa by ft US C.e.a Fd" se -W. Total Gross Weight: <br />for trsapoa aaard4�8ta epplloble.ewamaat m8.l.tions end Oeyarenetfe of Trmgwaatlon. enerarappropletnsua auies and aeydaaa.. Minus Tare Weightf: � <br />Total Net 99: F <br />Customer Name:R'Litodilatus Customer Signature., Date: <br />(Please Printwil Name) (Plamie Syn FULL Name) L V <br />/6 <br />Route Driver:Im Route Driver Signature: Date: <br />f Please Print FULL Name) ( e) <br />certificate of Receipt: Certification of receipt of waste as covered by this tracking document number. H9 11 -1-e Services, 49M E. Uncoln Ave., Fowler, CA 93625 <br />Transfer Driver. Transfer Driver Signature: Date: <br />or Discrejumcim <br />Certificate of Receipt o of waste as covered by this tracking document number. n / 123 <br />it ♦� /� <br />Signature: d1� s ate: <br />Certificate of pestrucdon Ceriflca333 Ts 49 <br />tio destruction of waste as covered by this tracking document number. Heaandsa Sovkm 48M E uncoln Ave., Faw(e , r: s 3 <br />Signature: Date: Transporter Permit #WA <br />Detptaee - FadAty <br />Atm Did F=W <br />APoweuta iowknatad Fadi ty <br />Akwrram Dm%nated FadMy <br />Mwnute pm%n od Fadlty <br />+AlW ate Did Fadhy <br />Alternate Dadp+eted FadCty <br />Aitamate Dmynsted Fad fry <br />supedor Medias Waste, Inc <br />Nealthv s ser U.0 <br />Nadorat Green Gas, [LC <br />267/269 S. Artaabead Ave. <br />48M E Untabe Ave. <br />82379 Fbnft Way, Suite F <br />San 8eoardhw, CA92408 <br />F*vA-, CA 936]5 <br />kKW CA921o1 <br />(800)9734030 <br />(559)834-3333 <br />(760)347.4422 <br />Peradte 123 <br />Permit a 75,89 <br />Pena88TS-W-99 <br />Transporter Pem tk 6324 <br />T&nRVrterPerm1t:6070 <br />