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or Medical Waste CA <br /> '%perior Medical Waste, , 2 69 S.ArroWhead Ave, <br /> ° San Bernardino,CA 92480 <br /> Document (800)973-4430 <br /> Tracking Tracking <br /> Transporter Permit#5687' <br /> Transfer Station Permit#123 <br /> EPA#GALtIf10401 79 <br /> Contact Information <br /> senerator Information <br /> PHONE- <br /> game,. <br /> Site#: i;l.4-T 24 HOUR EMERGENCY:PHONE: <br /> li €rrti ,x_are acili*. <br /> Telephone: 203-467-46571 Support provided by Ghemtrec <br /> Address, 170,7 5.Auvfir# Road <br /> City' i State. Zip: Route: Ream, <br /> aaaveradto4-93 I <br /> peancontoMera <br /> UN3291, Regulated Medical Wastei, n.o.s.,6.2, PG 11 <br /> Picked.Up FroM Customer <br /> ON <br /> c-ontainer Weight Container Qty. Weight Container y Qty, Weight <br /> container <br /> r' Qty. W <br /> eig, <br /> ht container y <br /> W6 e <br /> 20 <br /> 20taa( <br /> 20 <br /> 28 <br /> 39! <br /> 40- <br /> AO' <br /> 44 <br /> 49 <br /> 96- <br /> S -I,Oi'AL <br /> a t ISUOTOTAL U8-TQTAL SUB-TOTAL <br /> comments,L Now, Or vwa <br /> Signatures For Compliance and Authorizations —�- -- Total Containers: <br /> I,, .dedare ttFatafl�mntantafieonsnmerx are tsdty ane'accu�ac�raebtrltra Ptri +Dar rturn,erdaaar. »���owasteis iraeWhararcbus'sne�+ne*cun 'Otai Gross Yd8tr <br /> 1 -- <br /> anaandarac P .markedand and arebYeDeSpRCtiinproparrdtt as�fine66Y0+oicWpedeia4 mdJar gt: <br /> tortransportaccordir to 'gou®mmemr uiataonaand;0epartnn:ato(Tra spona#on,, anetor Sralekaka«eta�ataoana: Minus Tare Weight: <br /> Total Net Lbsi: NO <br /> Customer Name': Customer Signature: _ Date: <br /> lease FULL N <br /> Sign FULL Na <br /> Route Driver: Route Driver Signature; Date: <br /> (Pie rint FULL Nand {Pi gn FULL Name) <br /> cermate of R Gerttfication of receipt of wash as covered by this tracking document number, Heahhwise services,48M E.Lincoln Ave.,Fowler,CA 53635 <br /> Transfer Driver: Transfer Driver Signatures: Date: <br /> (Plea- PWAAL Name) {pucesignFULL Name) <br /> certt8ialte of ipt Certification of receipt of waste as covered by this tracking document number. waw 0.4edicaiwasta,iv 2b7645,Arrowhead Ave.,Son aemaratrw T:s�ao-973,4430M»i <br /> hate;, <br /> Signature: <br /> Uncoln <br /> -89 <br /> Date:,Certificate of Destruction:ceriflcation of destruction of waste as covered by thlstracking document member. Hea{thwae service F Date"Ave.Fowler,CA 93625 T:$594B4-33n T5 Transporter <br /> Signature: <br /> Fadihyr Anernate ACs naterd Padiity ei. Facility Ahemate Facility AlternateQeadnate�d Fiadity A)�rnate cid Facift d Fad)ftyDeskitated Designated FadGty <br /> Superior Medical Waste,Inc Healunviseservice,LLC: Wmnmerdal Uc <br /> 267/269 S.ArrowMad Ave. 4800 6.Uncoin Ave. 1463 Fayette St. - <br /> San semardino,CA 42408 Fowler,CA 93625 El Cain,CA 92020 <br /> (800)973,4430 (SS9)834-3333 (619) 3000 <br /> Permit#123 Permit#T5-89 Permtt#T5-DST-85: <br />