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9/2/2010 11:50 Remote ID <br />• o * Ster e <br />0.0 v1vW IM,le.l. -..* t: <br />BEVERLY <br />1221 ROSENME LAVE <br />STOCKTON, Ch 95207 <br />rint ID <br />D 3/8 <br />L WASTE TRACKING FORM NUMBER <br />STANDARD MANIFEST 001 -10 -06 -STD <br />MDFR008DB6 <br />(209) 477-2664 9/2/2009 <br />OawaRAToa's Rt OMPATM ! <br />2A. DESCRIPTION OF WASTIE <br />W. <br />i f a �.op� s <br />CONTAINER TYPE 2C. NO. of: <br />20. <br />VOLUME <br />4. TRANSPORTER 1ADDRESS: <br />REGULATED MEDICAL WASTE, n.o.s..6.2, <br />Sterlcycle, Inc. <br />T957 - <br />90 tial Tub t1EAio! (12 cu ft) CONTAINERS <br />AppficWo Per`r"l Numbers: <br />Freeno,Ca 93722 Th is Tht:ou h Shipment <br />UN 3291, PG 11 <br />V <br />Pwarype Name TC&I d< . Qtr Signature <br />Dae <br />S. INTERMEDIATE HANDLER 2 / TRANSPORTER 2 ADDRESS: <br />Phone 6: <br />Cu Ft, <br />REGULATED MEDICAL WASTE, n.os..8.2. <br />INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Receipt of medko waste as downbed above. <br />T949 - <br />37 tial Tub (1910' (4.9 Cu tt) <br />Dae <br />A 6. INTERMEDIATE HANDLER 3 / TRANSPORTER 3 ADDRESS: <br />Phone 6: <br />UN 3291. PG II <br />AppNomble Permit Numbers: <br />INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Receipt of medical waste as desabod above. <br />PrMType Name Sipnetura <br />Date <br />Cu FL <br />REGULATEDMEDICAL WASTE, n.o.s.,6.2, <br />T111114 - <br />44 tial Tub (810) (S. 9 Cu tt) <br />S . <br />Cu Ft. <br />REGULATED MEDICAL WASTE, n.o.s.,6.2 <br />_ <br />o Cu <br />UN 3291. PG 11 <br />Cu Ft. <br />WASTE, n.os.,62. <br />T815 - <br />20 Gal Tub (Path) 42.7 cu tt) <br />UN 3291, PG II <br />Cu Ft. <br />REGULATED MEDICAL WASTE, n.o.s.,6.2. <br />TY15 - <br />20 Gal Tub (Chemo) (2.7 ou ft) <br />UN 3291, PG it <br />Cu Ft. <br />REGULATED MEDICAL WASTE, n.o.s..6.2. <br />UN 3291 PG it <br />Cu Ft. <br />REGULATED MEDICAL WASTE, n.os.,6.2, <br />UN 3291, PG II <br />CU Ft. <br />Pharmaceutical ttastte <br />rg Ft.Q <br />3. Generator's C" : M hereby deders, 91st the contents of Mis consirmorn ate hay and A TtDTAI.$ �' ' <br />.e....ele...e/ mb-- M...sa .....e....wl...de.,....� .nA — ni...ifi®,d —.&.—A —d -A noel I.IuNmtthd.w.eei.et,. <br />Jam. ! <br />Cu Ft. <br />aro In all in proper condition for to _ international and natal tom" <br />i f a �.op� s <br />at Z Q <br />siv <br />Date <br />4. TRANSPORTER 1ADDRESS: <br />Phone 6: 9) 276 L 0994' <br />Sterlcycle, Inc. <br />4135 t ft Ave. <br />AppficWo Per`r"l Numbers: <br />Freeno,Ca 93722 Th is Tht:ou h Shipment <br />: Receipt of mediost waste as above. <br />TRANSPORTER CERTIFICATION: <br />V <br />Pwarype Name TC&I d< . Qtr Signature <br />Dae <br />S. INTERMEDIATE HANDLER 2 / TRANSPORTER 2 ADDRESS: <br />Phone 6: <br />AppkWU Permit Numbers: <br />INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Receipt of medko waste as downbed above. <br />Pdnt/Type Name Signature <br />Dae <br />A 6. INTERMEDIATE HANDLER 3 / TRANSPORTER 3 ADDRESS: <br />Phone 6: <br />AppNomble Permit Numbers: <br />INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Receipt of medical waste as desabod above. <br />PrMType Name Sipnetura <br />Date <br />.: ♦�:: :.: CYCLE STEMC.,, <br />INC <br />oil W MNOFMSAVE. 27?5 8 Zffj <br />I have been authorized by the applicable <br />Paccordance With the requirement o ab <br />Untreated medical wastes and that I have <br />Date SEP 0 1.2009 <br />