Laserfiche WebLink
gg&perior Medical Waste <br /> /269 S.Arrowhead Ave:. CA <br /> A7 <br /> �� i Y'1i San Bernardino,CA 92480 <br /> 1 1r 1`I 1 ( )973-4430 Tracking# <br /> Transporter Permit#6324 <br /> Transfer Station Permit#123' <br /> ALLIEU EPA#CAL000401279 <br /> Generator information JC#rv> Contact information <br /> Name: t t ¢ Site#. 24 HOUR EMERGENCY PHONE: <br /> Address: I Telephone; Support provided by Chemtrec <br /> City:. ; ' R State: Zip: Route: 1-800-424-9300 <br /> Delivered to Cusbomw•dealt containers <br /> U 3291 Regulated Medical Waste, n.o.s., 6.2, PG 11 <br /> Picked Up From Customer <br /> Container Qty; Weight Container Qtv. Weight Container Qty. Weight Container Qty. Weight Container Qty. Wei <br /> 20 20' <br /> 28 28 <br /> 38 38 <br /> 40 - 40 <br /> 44 44: <br /> 96 96 <br /> , <br /> SU6-TOTAL SUB-TOTAL SUB-TOTAL SUB-TOTAL : SU&TQT,4t <br /> 11 7e- <br /> Notes,Comments,or Discrepancies <br /> Signatures For Compliance and Authorizations <br /> Jahipplazaam <br /> hereby declare that rhe content ofthis consignment are fully and accurately described above W proper tFarther decianthat Mrs dupmentof waste a freeMhaaardos andmemMTotal Containers <br /> e and am dassMed,packed,marked and labeled,Arad are in all aspects in proper condition wastes as deened by McMS C ofpederai and% I Total Gross Weight: <br /> for transptut acmrdlag to applicable govamr nt ragutadonsaMl Department art`rensporrstion, anwor appropriate Rat.Rules add Minus Tare.Weight: <br /> Total Net Lbs <br /> Customer Name: ✓ Customer Signature: ea (Tate: 71, <br /> Please Pri FULL Name} l si LL Name) <br /> AO <br /> Route Driver:. I/l/I A Route Driver Signature: //, Date: <br /> (piease P Xf <br /> Name) (Please si f Nath} <br /> Certificate of Receipt: Gertificatioeceipt of waste as covered by this tracking document number: a wise Services,48t)<J E.Lincoln Ave.,Fowler,CA 93625 <br /> Transfer Driver: Transfer Driver Signature; Date, <br /> (Plea_*Ant FULL NB (Please Sign FULL Name) <br /> Certificate of Receipt. iii on ( Ste as covered by this tracking document number. TS-123 <br /> Signature: <br /> Certificate of Destruction;Cerificeticin of tie ion of waste as covered by this tracking document number. Heatthwise Services,4e00 E.u»aoin Ave.,Fowler,CA 93625 T:559-834-3333 Ts gs <br /> Signature: Date: Transporter Permit#6o7O <br /> Designated facility Alternate Designated Facilityate Designated Facility Alternate Designated facility Alternate Designated Facility Alternate Designated Facility -kismate Designated Facility Alternate Designated Facility <br /> Superior Medical Waste,I= HealthwiseService,LLC Medical 6tyAmnmemaikcimm4kgies,LLC` <br /> 2671269 S.Atrowhea4 Ave. 4800 E.Lincoln Ave. 1463 Fayseat St.. <br /> San Bernardino,CA 92408 Famder,CA 93625 €i Cajon,CA 92020' <br /> iB00)473.4438 (599)834.3333 (619)448-20DO _ <br /> Permit 8123 Permit 9TS-89 Permit A 7S•-OST-S5 <br /> Transporter Permit:6324 ITansporter Permit-.6070 <br />