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_....... ........... <br /> rior Medical Waste <br /> edical Waste, Inc. 41269 S.Arrowhead Ave, CA <br /> SanBernardino CA 92408 <br /> Tracking Document ($00)973-4430 Tracking <br /> Transporter Permit#6687 C 0 iw R 4 1 <br /> Transfer Station Permit#123 <br /> EFA#CAI. x:279 <br /> Generator Information Contact Information <br /> Name: California 44ealth mare Facility '; Site : C K F 24 HOUR EMERGENCY PHONE: <br /> Address, 707 Austin Road Telephone. 2009­4967-066$7Support provided by Ghemtre€. <br /> City: _ State: Zips Route: —' ,� 1-800-4249300 <br /> - " Delivered to customer•awn 00"ne" <br /> 1, Regulated Medical aste'. . .s., 6.12, PG 1 <br /> Picked Cllr Fess Customer <br /> INyg(y" $• Wy liu�Siorn6m.'" �R . �a t,q,.,. <br /> Container MY., Weight Container Qty. Weight Container Qty.; Weight Container sty. Weight Container Oty. Weight <br /> 20 <br /> ao. <br /> 36 38 <br /> 4040 <br /> i4444 <br /> ELIB:F.<YrIU. St3tt8.tOTAL SLM-TOTAL - sull TOTAL.., 5U8-TOTAL <br /> Not",comments,or oboeliancles <br /> Signatures For Compliance and Authorizations <br /> E==d, <br /> ncofthsomsi$nmeritareftftandaccurately4 at.o"byproper rfuarrerdadaretAatiR 0twstea,*ae rhew*�endnmairy TotallContainers;paccked,marked:wW labeled,and are in a8 aspects in proper condition wasaea as dettned WmaUs cede d pedararRequtatiomamljar Total Gross Weight:sportaaordtn8toapp8eable _ treguiaznnsand Department ofTransporta6ona{esadd" iinusTare Weight: <br /> Total Net Lbs: <br /> Customer Name: Customer Signature: AF pates <br /> ease Print FLiLL te} � (Ple,041.FLU Nem <br /> Route Driver: Route Driver Signature: gate: <br /> (P se Pr1nt AL Name) (Please Nam"e)S <br /> to of Receipt; reification of recelpt of waste as covered by this tracking docurritint number. althwisa Services,48�E.Linenlit.Ave.,Fowler,CA 93615 <br /> Transfer Driver.: Transfer Driver Signature: Bate: <br /> (Please Print FULL Narrie) (Please Sign Full,Nam) <br /> Certificate of Receipt: Certification of receipt of waste'as covered by this tracking document number. SapwW Medical Waste,Inc.,167/269 5 Arrowhead Ave.,San Bernardino,CA T:N4473-4434 Ts-123; <br /> Signature: Date: <br /> Certificate of Destirtictioiltz Cerification of destruction of waste as covered"by this tracking document number.. a services,4=E.Lincoln Ave.,Fowler,CA 93625 T:6394334.3333 73-99 <br /> Signature: Date: 'Transporter Permit X70 <br /> d Facility Aibrnateresignated D Feaility Afterrtatit Pae ty Allsi l0aignated fatltity De ed Faeilitk AJtarrrane rias Pad y A Designated Padiity <br /> seper'ror:Medical Waste,Rx. tiealthwkeSer ice,LLC: Erwiiorirr lTedmoieEdes,LLc <br /> x67/269.5.Arrowhead Ave. 48ME,UncoinAve.. 1463 Fayette St <br /> San 6cmardino,CA'32408 Fowler CA 93623 EI Cdlcnt,CA 92026 <br /> (8�)4T34430 (558)834-3333 (619)448.2000 <br /> parmit#123. Permit#TS-89permit#Ts-0sT-85' <br /> Transporter Permit:6687 Tansporter Permit:som <br />