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111perior Medical Waste, Inc. error medical Waste <br /> /269 S.Arrowhead Ave. CA <br /> 40 <br /> San Bernardino,CA 92408 <br /> . ( 00)973-4430 'Tracking <br /> Transporter Permit#6687 <br /> Transfer Station Permit#123 <br /> EPA#CAL000401279 <br /> Generator Information Contact Information <br /> Name: California 4aalth Care Facility Site : CqCF 24 HOUR EMERGENCY PHONE <br /> Address: 77C7 S.Atstin RoadTelephone: 2019-467-46S-1 Support provided byChemtrec <br /> City: Stoc State: �A Tip Route: 4 n � 1-800-424-9300 <br /> - ...." - Delivered to CtrstMM•Ctean-Carta9ners:.... <br /> 1, Regulated Medical Waste, n.o.s , 6.2, PG 11 <br /> Picked tip From Customer <br /> sh <br /> E MEMO ffimm- <br /> Container QtY,. Weight Container Qty: Weight Container qty:. Weight Container Qty. weight container Chyv Wei& <br /> it <br /> 20. <br /> 28 38 <br /> 96 <br /> SUa70TAL SUS-TOTAL 511$-TOTAL S -TOTAL $ aVTA4 <br /> . NOtes;CamOnettts,or Ducrepancles'. <br /> Signatures For Cc trtpiiance and Authorizations <br /> lherebydedarethatth ¢4lttarffltNts arefoirranaacarataly8esuibedabovaMProper 11eeNre tdatdais orwasMafreeoFb anAma%uaY; TAtalConlalnlarz <br /> htpping nbma atsd ora <br /> packed,marked-end labeled,aril are in all Aspects In proper condition: aideaned ErytheUS Cade died"P4U andAV Total C7ros5'vdeight: <br /> frp#am tteceoralnstoapp 'abte rPmentrPgolatiardsantlDeoa+tm�tcdTranapµrtatior+... andAr .Soteaaias.ar�8. i4iirluSTate 1M1l Weight: <br /> Tt?tct Net Ldsc Ak <br /> Customer Name: Customer Signature: lets; <br /> ( ease PeiM Ft)U ne) ( gn LL Nam �.., <br /> Route Driver: Route Driver Signature. Date: <br /> Itirfi;ationof <br /> se Print [L Namel (Pleas®S 4Q.Name) <br /> Certificate of Receipt receipt of waste as covered by this tracking documJant number, aitFnAiSa cervices,4WO E.Lincoln Ave.,Fowler,CA 93625 <br /> Transfer Driver: , Transfer Driver Signatum [date: <br /> (Please Print FULL Name), (Please Sign FULL Name) <br /> Certificate of Receipt: Certification of receipt of waste as covered by this tracking document number. superior Medicaiwaste,mc.,267/,2695.Arrowhead Avc,San aernardino,CA T- 973.4430 TS-123 <br /> Signature. Date: <br /> Certificate of ion:Cerifieation,of destruction of waste as cohered by this tracking document number,. ioalthwise sen k;es,4800 E.Lt In Awe.,Fowler,CA 93625 T.5s9-834-3383 75-29 <br /> Signature: pate. TransporterPermit#6070 <br /> Veortilted Fadnty Alternate Designated Ped Wy Alternate Designated Fasdlity Atterom Designated FacMW Alternate Designated Facility Alternate DesUpkitect Fadity Afternaba Designated Fadlity Alternate L>uWnated Fadtity <br /> Superior Medical Waste,ince fiealthwise:5"aroice,kt`CMedical EWA=meow Te&A_ ii.0 _ <br /> 267/269 S.Arrowhead Ave.. .49M E,Lincoln Ave. 1464 Fayette St. <br /> San ecmerdlno,CA9240$ fowler,CA 45625. El Cs)ott;CA 92020. <br /> two)9734480: (559)834-3333 (619)448.2ma <br /> Permit#'123.. Permit ATS-S9" Permit#TS-OST-85' <br /> Transporter Permit:6687 Tarsparter Permk:6070:. <br />