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'or Medical Waste <br /> ior MedicalWaste, - . 2W69 S.Arrowhead Ave. <br /> C <br /> San Bernardino,CA 92480 <br /> i { <br /> I <br /> Tracking Document 800}973=4430 trarkii7g <br /> Transporter Permit Al 6687 <br /> Transfer Station Permit Al 123 <br /> PFA#CAL000401279 <br /> Contact Information <br /> ienerator Information <br /> ;li <br /> dame: C 1 fDi'i'ii_ ajt r p <br /> Site#-. .�„���` 24 HOUR EMERGENCY PHONE: <br /> Telephone: �i� X 4 7 Support provided by Chemtrec <br /> address: r <br /> State" Zip: C;. Route: 7 4-93tR# <br /> "ty* gt ' <br /> - D�iveredto -deaA <br /> 3291, Regulated Medical Waste, nao.s., 6.2, PG111 <br /> Picked Up From Customer 777 <br /> r., �� <br /> Container Qty. WeightContainer Clty. Welght Container ptl. Welsht container Qty. Weight <br /> M <br /> 20 <br /> 28 <br /> 29 <br /> 3a <br /> 38 <br /> ail <br /> as <br /> 4a; <br /> Si18 TOTAL SUB-TOTAL SU8-TD'TAL iU&TOTAL 5LFB TOTAL <br /> Notes,Comment:,or 011screpandes <br /> Signatures For Compliance4ndAuthorizations <br /> lho tha Nos cent�at afUlls cw*naxntare haiiyand#acwatgly doixibed abowbyproper I Nnhw dgciare Nwtdns desats k4reead a •merwry Tr}tai Gorltalner4 <br /> da�i±t!!iru andazadasgi6ed.pecked,marked`aaidlabe&f,and arefaaa6aspectsanp6aaPgrtandahm. waicaaas ,bV0*A)SCadedradaretWeVisdmandlw:. Totaleros6'weight: <br /> ' '69 gw>v�ment .and t7eperdnarR el;Ti af40, Szata Rsdes aeEd h us Tare Weight, <br /> Total Net Lbs: <br /> Customer Name: Customer Signature: Date: <br /> (Pla, a Print FULL <br /> Na 4?te <br /> FULL�Na <br /> Route Driver: � Route Driver,Signature., Date: <br /> ( Prim FULL Namel AV <br /> FULL Name] <br /> Ce of Recelpt. Certification of receipt of waste as covered ytltis traddng document number, shwise services,4 E.Lincoln Ave,F Fowler,GA 93b25 <br /> Transfer Driver Transfer Driver Signature: Date: <br /> (Please Print FULL Name) <br /> (Pleases lgnfULL Named <br /> Cert#tcate of rtecelpt: Certification of receipt of waste as covered by this tratkktg document number,. sapmrWMedicsl waste,inc.,267,12635,Aitipwhead Ave.son Bernardino,CA Tzz 130"73.4430 Ts-123 <br /> Date: <br /> Signature: <br /> Servt�s,48IXf E,Uiatnin Ave„Fowler,CR 93623 7:559=834333375-89 <br /> Certificate of Destriacttion.Cerificatlon of destruction of waste as covered by this track[ng document number. <br /> '' <br /> Date:. 'Transporter Permit#6070 <br /> Signature: <br /> Dasfinated Faedutjr <br /> C►es Facility Aiternata. Fatuity Alternate ,ted Fatiltty k <br /> III ted Alternate Designated Fadiby Alternate oeFacility Ake►nate 0"anated#acitty <br /> superlor Medical waw,Inc. Heafthwise Servke,LIC MKW Ermraamemal Teclnwlogim LLC <br /> 267/269 S.Arrowhead Ave.. 48W E Uneoin Ave. 1463 Foyette,St; <br /> San Beiaardlao,CA 92408 Fowler,CA 93625. El Cajon,CA 92020 <br /> (860)973-4450 (559)834-3333 (619)449-2066 <br /> Permit#.123. Pennit#T5-99 "Permit#T5-OST-85: <br />