Laserfiche WebLink
W160I <br /> Medical Waste <br /> u r is s cSmgraEjQ� ! 9 S.Arrowhead Ave. CA <br /> San Bernardino;CA 92408 <br /> Tracking Dc t (8O0)973-4430 <br /> Transporter Permit#6687 Tracking s r <br /> Transfer Station Permit#223 <br /> EPA#CALOO1279 <br /> nerator Information <br /> Contact Information <br /> Name: C Rf rf i 4 Care Facifity Site#: 24 HOUR EMERGENCY PHONE: <br /> Address: v it Road Telephone: <br /> Stats: Zip: Support provided by Cherritrec <br /> Route: <br /> City; r1 1 <br /> �'"" 1-800424-930 <br /> palwe wt4 cle"containers <br /> UN3291, RegulatedMedical Waste, mo.s., 6.2., PG !I <br /> Pkksd Up From Customer <br /> ;, �� � �� �avV � ���as _ E�s* �`r• ��, -.a�" `«�- � IMF <br /> Container Qty, Weight< Container Qty. Welsin Container oty. Weight Container Qty. Weighi Co talner s2ty. We' <br /> 20 <br /> 20 r. <br /> x8 <br /> 28 <br /> 3$' <br /> 4tjr <br /> 40. <br /> 44, <br /> 44 <br /> `96 r <br /> 96 <br /> SUB-TOTAL SUB-TOTAL <br /> Still-tt5TA1 5#1B,TUTAi. <br /> - SU6 TQTAt <br /> Notes,Camra s, laereponcles <br /> Signatures For'�ompliante and Authorizations <br /> y aM"BPpkCta111C sro gnmenutatW4Bfoudlymd a <br /> ranmcnt pT andspdo4+rotVatt r. Wal a/orarskdarola demstwihhais mUahS irCPemos g�rRni'a,t�t�nawg maaisew'Snsi.r¢_f oGfOhMaiasnr�d1wP�r�'d <br /> ndmartwY T4�1�)nYAIFkr5: <br /> Total Gross Weight: <br /> N11hus Tare Weight: <br /> and ate <br /> C ,Padm3iakedand}ygpfed,arId r <br /> einelaspecorrprapcmdkwn wast@ofdoR=Q}ttR <br /> e <br /> Wet• 5 <br /> Customer Name: t, 14iP Customer$!gnatu <br /> Date: <br /> (Pie a Print FUtt Ne �. � <br /> e Sign tt:" }. <br /> RouteDriver: Rotate Drivsr Signature:: Date: <br /> (Please n UL4 Na4Tie) {Please n , uu Nast ) <br /> certmtate of Recelpt Cert' catkin of recdlpt df Waste ase red bythistracking document number. eafthWlse Services;481111 E.Lincoln Ave.,Fowler,CA 93625 <br /> Transfer tJriusr: Transfer Driver Signature Date: <br /> (Please PrintF ) (Please Sign FULL <br /> Certjfi'cate of pt: Certifl eipt as covered by this tracking document number, F <br /> 0 Ave:;son T,. 34430 Ts-123 <br /> Signature: a <br /> Clai tlfj ate of ctlan;Ceriflcatian of d cNon of t�as Bred by this tracking document nurltlaer: wealthwtsa Semces 48 1 i.Unm[n Ave.,Fmuter,cA 93szs r s' s34 s33 TS 89 <br /> >ignature: Date: <br /> Transporter Permit#6070 <br /> X%WMW Fecliity Altemate ted fattlitq —A%emote Oesignoted Facility----Altelrnate Des l igtwted Faculty: Aaternate aeslgnated FacNityMernateCiesigootedfadlity Aft a I M I Its Designated Facility <br /> taper7orMedical Waste,Inc HeaRhwiseService,LLC Medal ntaiTAch .LLC <br /> _ a <br /> 67(269 S':Arrowhead Ave. 48W E.Lincoln Ave 1463 Payette St. <br /> an Bernaramo,CA 42408 Fowler,CA 93623 El Cajon,CA 92020 <br /> 300)973.4430 15591834-3333 (619)448.2000 <br /> ormir 4173" Permit#TS-89 Permit#TS--OST-85 <br /> ransporierr+armit:"66$7 Taissporter Permit:5070 r_.. <br />