Laserfiche WebLink
lu i , t rir�r Medical Waste <br /> r Medical Waste, . 4&269 S.Arrowhead Ave.. CA <br /> -OqTTracka <br /> , �. Salt Bernardino,CA 924{36 <br /> Document ( aa) 4430 <br /> 1 Tr kil g ,. . <br /> Transporter Permit#6687 - <br /> Transfer Station Permit#123 <br /> EPA#CAL000401279 <br /> Generator information Contact information <br /> Name: zlifomia, � f ° F .ltl* ; Site M ;-Hc,; 24 HOUR EMERGENCY PHONE: <br /> Address: 7-7r.,R S,AvrdtT Rvad Telephone' 7 'r Support provided by Chemtrec <br /> City: _ State: r 21ps._ Route. 1 1-800-424-9800 <br /> .. _. Qellver"ftauimner-clean c4o"hets <br /> U1, Regulated Medical Waste, n, .sa It <br /> Picked Up From Customer <br /> 77. <br /> MM <br /> Weight Container Qty, WeightC MerContklner Qty. Weight Cont nor city. Weight <br /> 20 20 <br /> 2a 20 <br /> as: 1 <br /> 40 40 <br /> a9. 44 <br /> SUtt TOTAL SUO-TOTAt, SUB-TOTAL SU&70TAL, SU&T <br /> Notes;Cbmmets,or Diser"andes <br /> Signatures For CDmpliiance and Authoriiatibris <br /> ltrare6ydaclarothatmwcnnsemor ews�t�ttareetwHa rrakeHfescr€braabcvebyPmpsr ltukKtsaaaaramatafsshlpmeMa anaisfree�hs:■rduuiat mercwy Total Containers: <br /> ahlppin8 ttarrte and att' ,Padted,markad'and tabalad,artrl'ate m�laapecrs in prapar eandil{an as deihi 0"t+Y thail5fade eE r.¢de»! .. 'of+s fc4cP Total Gross Weight:'. ... <br /> rar anspertacemamataapitlr severnmentre&wwnsaad;ttePgnme t4f;rransp at n arwor approprWaStMAtAs and Minus Tam Weight. <br /> Tot et Lbs: <br /> Customer Name: �t ° t Customer Signature: Date: <br /> cease Ptinviju.Name) Sign FULL Na <br /> Route Driver: Route Driver Signature:_ Date: " <br /> i Print FULi.Name) it ease sign Fl . aniej <br /> Certificate of RaIC610. Certification of receipt of waste as covered by this tracking document number. Heaftiiwise Services,4800:E.Lincoln Ave„Fowler,CA 95625; <br /> Transfer Driver:_ Transfer Driver Signature: _. . Date: <br /> (fiiea5e Print FULL Navy-,*' <br /> a (Please sign.FULL Nernst <br /> Certificate;of Receipt Cert' eipt of', a covered by this tracking document number. T5-133 <br /> Signature: <br /> Certificate of oestruction:Ceriflcation of ion ofw as covered by;tetls tracking document number: lttawlse services,ns0o t.IincoAt Ave,Ebtvler,CA93625 T;559$34 3333 TS-89= <br /> $1gjiature: Date: Transporter Permit#6670 <br /> Sadlky Aftmte Designated Facility Alternate Dastputed Facifty Alternate Fedtih Aiterriata beaignated Facility Ajtemete Des d FadMy Alternate Designated Faell Alternate Daknated Facility <br /> Superior M%ttal Waste.Inc Heaftwise;Service,LLC Merikal Emkonmerbi Tedmolodes,LLC <br /> 267/269 S.Arson head Ave. 4800 F.Lincoln Ave. 1463 Fayette St. <br /> San Bernardino,CA 82908 FOWW,CA 93625 EtCajme;CA 9202.0 <br /> (8{10)973-4430 15591889-3333 (619)448-20 <br /> Permit,#123'. Permit#.TS-89 Permit#Tr-0ST-85 <br /> Transporter P—It,61587 answrter Permit:6070 <br />