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9%2/2010 11:50 Remote YD Y rfnt ID ® 5/8 Rp MEDICAL WASTE TRACKING FORM NUMBER ® Sterkyels' IN CASE OF EMERGENCY C C MTREC 1• 0.231.00S1 STANDARD MANIFEST 001-t0-0o-STO • � .111"M Route 02 - hS MDF'R0088G2 1. Generator's Name, Address and Telephone Number A= BEVERLY CHATZhUS 5#567 1221 ROSEMME 1ANK STOCR7011, CA 95207 2A. MWAUnON OF WA REGULATED MEDICAL WASTE � I fl 111111111161611111111111 i (209) 477-2664 7/29/2009 GIR MAMPM RESI.TMTION e TvS7 - 90 tial Tub Me) (12 au ft) Pharmaceutical waste IC. NO. OF 120. VOLUME CONTAINERS S. GorwaWs declare that the contorts of this are frAly and ( TOTALS ► , I EA -1 C described above by the name. and are classifisti, paclaged, marked and labeffeWplacarded, and are In an respects in proper corMw lor tmngm acconang to appilcable International and national governmental re,P,u 4. TRANSPORTER 1 !1 S: Phone #: - S ri lo, Inc. 4136 t ft Ave. Applicable P Numbers: rresno,Cs 93722 This is a ro h Shipment TRANSPORTER CERTIFICATION: of above. PdnVNNpe Name 6 V. TQ r Signature Date 712 S. INTERMEDIATE HANDLER 21 TRANSPORTER 2 ADDRESS: Ph" #: LU Appk&e Permit Numbers: INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Reeelpt of medical waste as described above. PrinVType Name Signature Date 16. INTERMEDIATE HANDLER 3 / TRANSPORTER 3 ADDRESS: Phan C EApplicable Permit Numbers: -ERMEDIATE. . •nxkai waste as described above. i Name Dots [j 31 CIE INC 4135 W. SW" AVE i. FRESNO .. O. Tf*Mhmkdr CU A to UC. Afterraft Pat": STMCYCLE INC 9053 NORRIS AVE. SUN VALLEY. CA 21352 (818) 504 • aw ckmvlrodnwwmpw"w TREATMENT FACILITY. I cendy that I have been authorized by the applicablejpt received the above inftated wastes in accordance with the requirement in [ZalnIn�T 1111). ANsrmde FwJ ttr: STERICYCLE INC 2775 E 287TH STREET VERNON. CA SM23 (323) 362 • R 6. P`115 ecxept untreated rnedicat wastes and that 1 have JUL 2 g 2009 REGULATED MEDICAL WASTE. n.o.s..6.2, T1111119 - 3-r trial Tale tollo► U7. V Cu T UN 3291 PG If REGULATED MEDICAL WASTE, n.os.,61, - ® Cu UN 3291, PG It REGULATED MEDICAL WASTE, n.o.s.,6.2. 111121 20 ' 7 100 ft Q UN 3291. PG 11 W REGULATED MEDICAL WASTE, n.o.s..6.2, -20 Gala Cu WU 1 N 329, PG 11 REGULATED MEDT AI WASTE. n.os..6.2. T riS 20 sal Tub (Cheaso) (2.7 cu UN 3291. PG 11 REGULATED MEOCAI. WASTE. n.o.s.,6.2, UN 3291. PG 11 Pharmaceutical waste IC. NO. OF 120. VOLUME CONTAINERS S. GorwaWs declare that the contorts of this are frAly and ( TOTALS ► , I EA -1 C described above by the name. and are classifisti, paclaged, marked and labeffeWplacarded, and are In an respects in proper corMw lor tmngm acconang to appilcable International and national governmental re,P,u 4. TRANSPORTER 1 !1 S: Phone #: - S ri lo, Inc. 4136 t ft Ave. Applicable P Numbers: rresno,Cs 93722 This is a ro h Shipment TRANSPORTER CERTIFICATION: of above. PdnVNNpe Name 6 V. TQ r Signature Date 712 S. INTERMEDIATE HANDLER 21 TRANSPORTER 2 ADDRESS: Ph" #: LU Appk&e Permit Numbers: INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Reeelpt of medical waste as described above. PrinVType Name Signature Date 16. INTERMEDIATE HANDLER 3 / TRANSPORTER 3 ADDRESS: Phan C EApplicable Permit Numbers: -ERMEDIATE. . •nxkai waste as described above. i Name Dots [j 31 CIE INC 4135 W. SW" AVE i. FRESNO .. O. Tf*Mhmkdr CU A to UC. Afterraft Pat": STMCYCLE INC 9053 NORRIS AVE. SUN VALLEY. CA 21352 (818) 504 • aw ckmvlrodnwwmpw"w TREATMENT FACILITY. I cendy that I have been authorized by the applicablejpt received the above inftated wastes in accordance with the requirement in [ZalnIn�T 1111). ANsrmde FwJ ttr: STERICYCLE INC 2775 E 287TH STREET VERNON. CA SM23 (323) 362 • R 6. P`115 ecxept untreated rnedicat wastes and that 1 have JUL 2 g 2009