Laserfiche WebLink
erior Medical Wastei <br /> r l r Medical Waste, Inc. 10126.9 S.Arrowhead Ave. GA <br /> San Bernardino,CA 92408 <br /> Tracking Dc (800}973-4430 Tracking# <br /> Transporter Permit#6687 C DICR 1,,4 <br /> Transfer Station Permit#123 <br /> EPA#CAL000401273 <br /> Generator Information Contact Information <br /> Narrie: t�tM9 iM r aa# Site : ;- mm IF 24 HOUR EMERGENCY PHONE: <br /> Address: `7707 S.AtstLn R a Telephone: 209-467.4 7 Support provided by Chemtrec <br /> City: S!rjtkjP_nState: rg Zip; Roche: 1-800-424-9300 <br /> "Ivered to Cestcmgr-Clean Containers <br /> 3291, Regulated Medical Waste.. n.o.s., 6.2., PG 11 <br /> Picked Up From Customer <br /> � � �, <br /> Container <br /> 4ty Weight Container Qty; Weight contalner Qty: Weight Container Qty. Weight Container City. Weight <br /> 20` <br /> 20 <br /> 28 28 <br /> 3$. 39 <br /> 40 40 <br /> 44 <br /> SUR-TOTAL SU$�Toriu I SUB-TOTAL SUB-TOTAL SU6•TOTAL <br /> Signatures For Compliance,and Authorizations *tea Conumnats,or 01screpanclas <br /> h�ebyifetlaret4cattf ranfent '3Pti3con3XSns art.amtutlYaruiaceuratetydexrtixda8ovebYPropes..... .. tlur cbtParatfiattMs wasffiIsfscdieaaardarsaasdmercury" <br /> Total <br /> Containers- <br /> for orrt a-wdwg i p bier mrneu4 resuEad nes and 2!L4 met 0f Trransaortatjoh, iwa aept�a & ,� Totai'Gross Weight: <br /> packed,tnprkdd an Cod. dans and/oe To <br /> Res" <br /> gnus Tare weight: <br /> Ale�' S# <br /> Total Net Lbs: <br /> Customer Name: _ Customer Signature: mate-, <br /> Paint FU ante) (Pr Sign Pitt rt!ai' _ ~ <br /> Route Driver- <br /> , Route Driver Signature: [date: <br /> &L-Print FttLLNanie) <br /> iPi eSigmfUlL � <br /> Garb of Receipt ication of receipt of waste as covered by this tracking document number. Healttrwise Services,4800E i incoin Aire,,Fowler,CA 33525'' <br /> Transfer Driver Transfer Driver Signature: pate: <br /> (Prase Print FUt1,Name) {Please Sign FULL Hamel <br /> Si of Receipts Certification of receedPt of waste a5 covered by this tracking docuitent number. 6Mdar rnadiaai W"t%iric.,26Vx$9 s.Arco-Mead Ave.,San sernardma,CA T,.800-973-4430 TS-123 <br /> Signature; Date. <br /> Certificate of tton:Cerification of destruction of waste as covered bythis tracking document number. Healthwise Services,48W e,Llncoh Ave.,'Fgviet;CA 9-M2S T.s59434-6333 TS=89 <br /> ilgnatute: Date: Transporter Permit#6070 <br /> Msignatecl Fat laity Alternate Designated Fa#Ftty Alta Designates!Fad4ty Alternate Designated FadNty Akemats 08318rwted Facility Alternate Designated Ferry Aftemaite Designated fadlisy Alternate Designated Facility <br /> uperior medical waste,inc Healthwise Service,MC MedicalEtt earrntentat LLC <br /> 67(2695;Arrowhead Ave, 4808 F.Uncoin Ave. 1453 Awft St. <br /> an$ernardlno,CA 92408 Fovvlar,CA 93625 V Cajon,CA 92020 <br /> X01973-4430 1559)834-3333; (619)401,2006 <br /> ermit 9123 Permit 2 TS-$9 Permit,#TS-_05745.. <br /> ransportezpmrmif:6R&7 TeiaspattarPermit,6070 <br />