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Medicalupenor <br /> rior Medical Wash <br /> J269 S.Arrowhead Ave, CA <br /> M Document <br /> �1+ San Bernardino,GA 92408 <br /> Tracking 1.1� c u 1 1 4 (800)973.4430 Tracking# � � r <br /> Transporter Permit#6687 �_ Iw AZ'x.1ors <br /> Transfer Station Permit#123 <br /> EPA#CAL000401279 <br /> nerator information Contact Information <br /> Name: i iff la ? ai i a�lffi Site : 24 HOUR EMERGENCY PHONE: <br /> H <br /> Address: 770,7 S.Austin Road Telephone: �e, <br /> Support provided by£heffiLreC <br /> City. :. State: Zip: Route: ,s .z 1-800-424-9300 <br /> DeNwitdi r-Man*w"low <br /> 3291, Regulated Medica! Waste, . . ., 6.2.. PG 11 <br /> Picked tip From Customer <br /> . - <br /> MW <br /> a <br /> container City, Weight Container Qty. weight Container Qty. Weight Container Qty. Weighs Leiner Qty. Wa, <br /> 20' <br /> 28 <br /> 33 <br /> 36. <br /> 40;'; <br /> 40l <br /> 44 <br /> SUOwTQTAl SUB-TOTAL 3ile-TOT4L SUB-TUTAI 5U8 TOTAL <br /> Motes,Co ,m JscrePprttiea <br /> Signatures For Compliance and Authorizations <br /> ihereby deedarathat q+eecgttentof"ons nkamftft edaccum*desi;N6paatwy�tlyprotMr tru�tur,�aeresi�at.tnrsahiv Fo€rr�ee:�arq'vcfMazary��and Ts#t�I.ContAinersi� -.. <br /> shippins name and we padred,marked and taparad,and',,inaitaapeminpmW-ondkior� asdaNnedd�Vtlret)SCONWKadaralRa9datio�an�oc 18L8iGross Weight: <br /> fat ansymat accwtbn@te app&able savarnmaMteBuiatBonsanci pcoartrrtenrtdfiranspattatian: oration 54ade sates aril$ ns, Minus Tare Weight::. a <br /> Net s <br /> Customer Name: . CustomerSignatu �' pate <br /> e .- <br /> Print FULL Na Ei} . .� <br /> esign PC ne} <br /> Adr <br /> Rautet{3river: Route.Driuer.Signature: Date: 0 <br /> {Please ULLNairel (Please nG00- <br /> Llitattse); <br /> ce a of tti ceipt:: Cert Lion of receipt f waste as" red bythis tracking document number: eaiLh>rrise Services,4Edii)E.iint�rin Ave.,Fowler,CA 93625' <br /> Transfer Driver; Transfer Driver Signature: Date-, <br /> l Print F ) (Please Sign FUL Name); <br /> certificate of Receipt: Certi#i ceilm as covered by'this tracking document number; 11111111111111111 P11111!11, ,San T: 3-_4430 TS-223 <br /> Signature-. XrR <br /> Certificate of Destructlow Ceriflcation fdBijKucuon of a as" Bred by this tracking document number. �--;,hwl-se v cps 4aal E:Linooin ave.,Fowler,cA 93s2s r s'-s3 333 Ts-g9 <br /> ii$nature: Date; Transporter Permit#6070 <br /> )OSIVUrted FacilityAltemate Designated ftcMtV Afterrate CIesignatittl Pacif ty Altem to Des i 1 ad0ty` Alternate,Designated Facility Aiternate Designated faeiiity Alternate Designated Facility <br /> uperlor Medicat wasta,inc. Fleakhs Service,LLC rApl s CLC a <br /> G7/269 S.Arrowhead Ave. f.Uncoiri Ave. 1453 Fayette St <br /> an Bernardino,CA 42406 Fowler,CA 93635 El Cajon,CA 92020 <br /> 300)973-4430 (559,4 834-3333r 2628}446.E <br /> ermit 4123 Pkrmit 4TS-89 Permit#TS--oST-85 <br /> tansportnrpevnitt&6V T.nspott Permit:6070 <br />