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9/2/2010 11:50 Remote ID <br />4 *-P Sterkyda• <br />• r+M•Ms,dala: <br />7 <br />Tint ID <br />IN CASE OF EMERGENCY CONTACT- CHEMTREC 1 23"031 <br />Rotate f: 301 — 3 <br />AT" it <br />BMW CM=hU STOCK70IN 0567 <br />1221 ROSMOMB LAINE <br />STOMMI, CA 9S207 <br />D 6/8 <br />MEDICAL WASTE TRACKING FORM NUMBER <br />STANI ARD MANIFEST 001.104"TD <br />1111111111111111 <br />09) 477-2664 <br />101111111 <br />aaa j <br />,r i, I <br />a a m - o•: r. r: c. <br />acCept untreated medical wastes and that I have <br />mom-, 1 I I ', <br />CuammNurnaa 6080855-001 O"MUTOOMREaaeT ym# <br />CYCLE INC <br />2A. DESCRIPTION OF WASTE 2111. CONTAINER TYPE <br />2C. No. OF 20. VOLUME <br />REGULATED MEDICAL WASTE, n.o.s.,6.2, <br />CONTAINERS <br />.1: 1.'.' <br />UN 3291, PG 11 • TB37 - 90 tial Tub (Idol (12 cu tt) <br />Cu Ft. <br />REGULATED MEDICAL WASTE, n.o.s.,6.2, T94 9. - 37 Gal Tub (Rio) (4 . 9 CU tt) <br />PG <br />UN 3291, II <br />Cu Ft. <br />CC <br />329TED MEDICAL WASTE, n.o.s.,6.2, <br />T914 - 44 "1 Tub (Bio) (3.9 Cu tt) <br />UN 1 <br />4 <br />REGULATED MEDICAL WASTE, n.0.8..6.2. ?923L- 20 Gal Tub (sio) (2.7 cu it) <br />I C <br />UN 3291 PG itCu <br />FL <br />W <br />W <br />REGULATED MEDT AI. WASTE, n.e.L,6.2, TI25 - Z® 6i1 Tub (lith) (2.7 CU !t) <br />UN 3291, PG II <br />REGULATED MEDICAL WASTE, n.o.s.,6.2, <br />' <br />UN 5291, PG II rVis - 20 Gal Tub (Chemo) (2.7 cu Et) <br />Cu Ft. <br />REGLILATED MEDICAL WASTE, n.o.s.,6.2, <br />UN 3291, PG 11 <br />Cu Ft. <br />REGULATED MEDL:AL WASTE, n.o.&A.2, <br />UN 3291, PG II <br />Ft. <br />rhamacaut.1C81 waste <br />3. Qww&Wft Caritifficustion:1 hereby declare that the contenle of tMs consignment ata fully and TOTALS ® <br />Cu Ft. <br />described above by the proper ah name, and aro , marked and later <br />� ge*i,6 <br />are la all respects In proper for aCto ice 11onsl and national Bove regWatiotre' <br />gran <br />/�flA <br />C'�/ S' attae <br />t P Nbtrrte+ <br />ate Q" (� ® Q <br />4. TRANSPORTER I ADDRESS: <br />Phone#: (559) 276 0994 <br />SteCicycle, Inc. <br />Appoost le Pam* Numbers: <br />4135 ftot Swift Ave. <br />F no,Ca 93722 11116 1t3 a C®ug .Sha nt <br />TRANSPORTER CERTIFICATION: Remot of medbal waste as described above. <br />r <br />PrinVType Name •li V. Signature <br />Date <br />S. INTERMEDIATE HANDLER 2 /TRANSPORTER 2 ADDRESS: <br />Phone M: <br />ev <br />Applicede Permit <br />INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Receipt of medical wants as described above. <br />Print/Type Name oats <br />`y <br />d. INTERMEDIATE HANDLER 3 / TRANSPORTER 3 ADDRESS: Phone N: <br />Applicable Permit Numbers: <br />INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Reew of medical waste as described above. <br />PdnV"e Name ftnature Data <br />7. DISCREPANCY INDICATION e <br />aaa j <br />,r i, I <br />a a m - o•: r. r: c. <br />acCept untreated medical wastes and that I have <br />mom-, 1 I I ', <br />DaIgnslad Facility: <br />CYCLE INC <br />4136 W. SWIFT AVI1 <br />FRESNO.CA 23722 <br />.1: 1.'.' <br />i. <br />! y <br />aaa j <br />,r i, I <br />a a m - o•: r. r: c. <br />acCept untreated medical wastes and that I have <br />mom-, 1 I I ', <br />