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rior`�Hedical Waste <br /> perior Medical Waste, Inc. 269 S.Arrowhead Ave; C1 <br /> . San Bernardino,CA 92408 <br /> TraCKing Document 'i(SPO)973-4430 Tmking# <br /> Transporter Pethilt#6687 C -Z' i!(E ) <br /> Transfer Station Permit#12:3 <br /> EPA#CAL000401279 <br /> Generator Information Contact Information <br /> Name- lif �r?ig q Site $ � 24 HflIJR EMERGENCY PHONE: <br /> Address: 7707 . v to R Telephone: 2 Support provided by Chemtrec- <br /> City: b w State: ( Zip:_. 2SZ Is Route, saav 2 1-800-424-9300 <br /> Deliveiedto 04tomer-clean cortalnees <br /> UN3291,1, a ulate a IcaWaste, n o-s., 6.2. P6 Il <br /> Picked U FrolTl Customer _y <br /> {{ <br /> Container My. Weight Container City: Weight'! Qty. Container city; Weight ,. Tier QW. -weight <br /> 20 20 <br /> 28 28 <br /> 38 3$ <br /> 44 40 <br /> 44' a4 <br /> 9r — 96 <br /> SU8-TOTAL SUBTOTAL. $L18-TOTAL '__ sua-TOTAL. 9u&T L <br /> Netes,;Comenents,oP ,..,nCle$ <br /> Signatures For Compliance and Authorizations <br /> rne�abyaeamrecnaet�ecm+tanteadn taseruey dam�atepaesaeaaal eavwsamr arur aea�ammtWs 7Z;;_ft RWOM 4 kee of hazardws4adMartury Total Containers: <br /> 09pieftnameand aredosdfied,pocked,nw*Adandlaaeto,a;Wart inaffaspeetsinpropercondition wipesaraeR "try the us Code:crFad%* :. t«msarwar Total Gross Weight; <br /> fortransportaccohdins to 9PAIRAW"Vemment roplatiomao D ofrransporWon andJara "saataRulesvad Minus Tare Weight <br /> To et Lbs: <br /> Customer Name: �1 i Vd' Customer Signature: C1ate: <br /> so Print LL Name} €FI FtYtt No <br /> hoRoute Driver. Route Driver Signature: Hate: <br /> €" Print BULL Name] (;ease sign Artie} <br /> Cartilicate of certification of receipt of waste as covered by this tracking document number: NealthWise Services,48M,E.Lincoln Ave„Fowler,CA 33625 <br /> 'Transfer Driver: Transfer Driver Signature; Date: <br /> ULL <br /> (Please Print FNa (Please Sign FULL Name) <br /> Certificate of Receipt. Cern eipt of e" covered by this tracking document number. TS-123 <br /> Wien <br /> Signature- <br /> Certificate of tfestruct€on:Cerif Cation of €on of ss covered by: Is trar�ing document number. tt}wise services,ISM L unc6k Ave.,Fowler,CA 93M T.Ss9,a34,3M TS-99 <br /> Signature: Date: Transporter Permit OW70 <br /> Designated Facility Aitemstecrated!Facfty Aftemate Designated facility Alternate Designated Fad tV agitate Designated Facift AftemateDalratedFacKity Attemate'DesignAtedFacift Alternate Designated Facift <br /> suparw Wadical Waste,Inc. Fleaithw se:Service,LLc Frwh+wimental Techroicsles,U.0 <br /> 267/269 S.Arrowhead:Ave. 48M L Lincoln Ave. 3463 Fayette St:. <br /> San Bamarino,CA 924N Fowler.CA936Xs El:caloru CA 92ma <br /> {BODY 973-4430 (sw 835-3333 }fi191449-2000 <br /> Permit 9123 Permtt#"_89 Permit#TS–GST-85 <br /> Transporter Perms:6687 Tansporter Permit;6070 . <br />