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Waste, 0or Medical Waste <br /> perio1 Inc. 69 S,Arrowhead Ave. CA <br /> 0 <br /> P San Bernardino,CA 92480 <br /> Tracking <br /> (800)973-4430 Tracking � a R2,0 �; <br /> Transporter Permit#6687 �� <br /> Transfer station Permit#123 <br /> EPA#CAL000401279 <br /> Contact information. <br /> Senerator information <br /> Site#' " 24 HOUR EMERGENCY PHONE, <br /> Dames ; jftirnia f_,s tf r Facility l <br /> �� Support Provided by Ghemtree <br /> Address: t_ Telephone: 2 ; �i=1 �: <br /> e 1 r` S. vi if" '� ' 1-800-424-3300 <br /> Route; r` m <br /> State: _ Zlp: _ oa8wered assn <br /> r - <br /> U 329 ., Regulated Medical Wastee .s. .2, PG 11, <br /> Picked Up Prom Customer IBM <br /> tantairler illy. <br /> Weigh container <br /> QW. weight Container QtW w'ght container ttty. weight CoI" r City. weight <br /> 20 <br /> 20 <br /> 2$; 38 <br /> 44 <br /> 96 <br /> 96 - st18-T03AL ISU8-TOTA1 <br /> SU6 TOTRE SUB TOTAL _ SUB-TOTAL _ NOW,comments,Or Discrepancies <br /> signatures For,Compliance.and Authorizations it dar ®"te d Total containers: <br /> { ,dsraectated,atma�en taFcrt er t+eare�i*and; %!"aluedROOM QYF-w- _ Tot%l6ross eight: <br /> sf.tPFp+Sr�anreaeedarad '.padredenarkeda3tdiaue�i,andarelndiasPactsinProPer ' adetU by aiausCodertredral ar�drer' <br /> .stpte atS arc aegWaso+u. Minus Tare Weight: <br /> toruwwport at.Wt" t na and DePa2menidTraaapartatkua. _ mar T Lbs: <br /> S <br /> r "LCCustomer Signature. {late: <br /> Customer ikixrr3l: 1,41 <br /> (Please Prin ULL Name) (l' S'" PULL Name] <br /> Route driver Signature Date: <br /> Route Drover: �� .�......,....W-.- <br /> om Print FULL Name) (piease Sign Name) <br /> of Receipt Certification of receipt of waste as covered by this tracking document number. Healthwlse Services,4800 E.Uncoln Ave.,Fowler,CA 91625 <br /> Transfer Driver Signature: Date: <br /> Transfer Driver: <br /> (Pie nt f,ULL Na )Please Sign FUMName) <br /> Ts-123' <br /> Certificate of Re+erpD cation' r aste as covered by this tracking document number. <br /> Signature: Ts 49 <br /> Haa(fhwise Servicas.4$08 6.Lhtt�n Ave., tnv�.CA 93625 T:55934-$333 <br /> Certificate of i?estruction:certification of destru of Waste as covered by this tracking document number. Date: Transporter Permit#6071 <br /> Signature: Akemate De ty <br /> d Fae <br /> Deslilinalkad Paahy Alternate <br /> Deaignated:FacilltY a Eadkyr De PaWky Alternate0eslB tad Facility Artemate nstedfadiity AMems Fedlrty <br /> Superior Madlestwast Am Heatthwlse!Wvke,LLC:. Erai3nmmaMat LLC. <br /> 267/269 S.Arrowhead AVO. 4800 E.Unco{n Ave. 1463 St. <br /> San earnardina CA92408 Fowler,CA.3625 Ei Cajon,CA 92020 <br /> (800)933.4430 (559)834.3333 (1619)448.2000 <br /> Permit#15--OST-95 <br /> Permit 8:123.. Parmtt4TS-89. - <br />