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rlMedicalperiorMedical Waste <br /> Waste., 7/269 5.Arrowhead Ave: CA <br /> M San Bernardino,CA 92408' <br /> Tracking C U (800)973-4430 C"V <br /> tracking �' t✓ <br /> Transporter Permit#6687 <br /> Transfer Station Permit#123 <br /> EPR#CAL000401279 <br /> Generator Information <br /> Contact information <br /> Name: 1 Site <br /> Address: L 1 V '-o 24 HOUR EMERGENCY PHONE: <br /> bb Telephone: Support provided by Chemtrec <br /> City: T�State: Zip:... � Route: <br /> 1-800-424-9300 <br /> Detirrerad M Customer-Clean Containers <br /> 32 , Regulated Medical se . .s. 1 <br /> Picked Up From Customer <br /> �,. MEN MEN NM <br /> Container City. Weight Container Ctty. Weight Container <br /> 20 City. Weight Container Qty. Weight Container Qty. Weight <br /> M . 20 <br /> 28 <br /> 38 -Ie. <br /> 40 38 <br /> 4044 . <br /> 96 <br /> 96' <br /> sll8-TOTAL SUB-TOTAL - 508-TOTAL '; ' <br /> SUB-TOTAL sub-TOTAL <br /> Sl natures For Compliance and Authorizations Notes,Comments,or Discrepancies <br /> trylarafhatthe content of this cons�rtmentare fuityandaauratalydescrdaad atwve by pmper rfartherdartare chat then "t of weste&free Mharerdousand matters Total Containers: <br /> J.-h—JopingZathe and are classified,Packed,marked aria labeled,and are in all asPacis in Proper corxRt3on wastes as by the US Code of Federal Total�ro9S.Weight: <br /> far transpart MaMft to a 8aeu(art&ae andlor 111111 <br /> applicable 8asremmam regufatloaa andpeparatientafiransportaY9on. and/or state ethsand R"Uhtions.. Minus Tare Weight: <br /> t l Total Net Las; <br /> �7 <br /> Customer Name: Customer Signature: Date: ` ff <br /> t <br /> (Please Print FULL email (Please Sign FULL Name) <br /> `ON <br /> Route Driver:— � AdV Route Driver Signature: <br /> -CL45;P'(-1 Datell�Af <br /> (Please Print FULL Name) (Please Sign FULL Name) <br /> Certificate of Receipt: Certification of receipt of waste as covered by this tracking document number. Healthwise Services,4804 E Lincoln Ave.,Fourier,CA 93625 <br /> Transfer Driver: Transfer Driver Signature: Date: <br /> (Pieria Pant FULL Name) (PieaseSigrt FULL Name); <br /> Certificate of Receipt Certification of receipt of waste as covered by this tracking document number. Superior Medical Waste,Inc.,267/269 S.Arrowhead Ave.,San Bernardino,CA T: -9734430 TS-123 <br /> Signature; <br /> Certificate of Destruction:Cedfication of destruction of waste as covered by this tracking document number. Date; <br /> signature: Heaithwise.5etvices,4800 E.Lincoirt Ave.,Fowler,CA 93625 T:559.834-3333 TS-89- <br /> Date: Transporter Permit#6470 <br /> 3aslgrtated Facglty, Aftemate Facility AltemWeDeSignated Factlity Alternate Designated Pa dittyAlternate€3esstgnat Facility to t>a <br /> mperior Medical Waste,Inc H"Ithw€seSerAce,Lit Envkonment�Tedmologies,LLC s� Faegtty .Alternate faifilty Alternate Designated Facility <br /> . <br /> 67/269 S.Arrowhead Ave. 4800 E.UnminAve• 1469 Fayette St. <br /> an Bernardino,CA 92408 Fowler,CA 93625 El Callon,CA 92020 <br /> 300)973-0930. (559)834-3333 (619)448-2000 <br /> ermit#123 Permit#TS-89 Permit#TS--05785 <br /> ransporter Permit:6687 Tansporter.PermM 6070 <br />