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9U/27/2013 TUE 14.-54 FAX 0
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<br />N: MICE DAT.-; 1/31119 7:55;04 AN
<br />CII LM 111pA – $64 BRIER ID: Para,
<br />4S46 SOLMY CT SAPPING1: 04}
<br />STOCKTON, CA 95207-- 7232
<br />20. NO. Or
<br />CONTANVERS
<br />an. VOLUME
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<br />AM UN3291,Regulated Medical Waste, 111.0,L,TEi4t 4 ;�
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<br />111 tom' '1� 1- 1
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<br />5 5226 i Regulated Madtcel Waste, n.o.s., i – 2fi Q;
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<br />.6.7, r Ill Regalatea wil" Waste, n-o's.,--
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<br />3.Oweratoes Cir NmIlon:'I hereby dedare ttmt the Oonlent
<br />desorlbed above the proper shipping name, end pre CAtsseIN
<br />111SI018 MICE:
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<br />! STANDARD MANIFEST 001.1 n--STU
<br />t" NDFROOE041
<br />7-0271 7/31/2013
<br />are In eg rp90e011e In ProPer rOo�ndmn for
<br />Irtylran�s Ottdat�xh4aord,/V to �y , 11>��om"
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<br />.4. TRANSPORTER 1 ADDRESS;
<br />Ete tiai:16, Inc. tidz is a
<br />"
<br />4136 1111.. Swift Ave
<br />rranno,CA 43722
<br />1 t RANSPORTER CERTIFICATION; Receipt or waste ae described arae.
<br />Rr rrrvr>s NaM �' e -y? e.'V Tu rra. — sl�tatwe
<br />5. INTERMEDIATE HANDLER 2 /TRANSPORTER 2 ADDRE6 ,:
<br />lvq E-7.17
<br />Date it , q/
<br />Rhone S: (68,9)275-2122
<br />AW[oe l® Permit Nunra;
<br />flaulac 3400
<br />Date . 70 f/1 -
<br />Y, 1
<br />1'APP&Able Permli N{utt4srs:
<br />S
<br />WiE1RA8EDIATE HANDLER /TRANSPORTER CERTIFICATION: Rewlil of maccal waete ee d@w1bed ebov46
<br />Prtnt/We Name f3lgnah,re oat
<br />s 6. INTERMEDIATE HANDLER 3 /TRANSPORTER 3 AODREGS: phone A:
<br />i
<br />Applicable Permit Nurnberg:
<br />E w INTERMEDIATE HANDLER /TRANWORTER CIE I TIFICATION: Rooatph of medical weals as descr W above.
<br />' Prlrlfljpe Name Signature Date
<br />T. DISCREPANCY INDICATION
<br />i y"
<br />IENT FACILITY: I certify that I have been authorized by the applIbable stats agency to accept untreated medical wastes and that! have
<br />the abouts indicated wastes in accordance with the requirement outlined in that aut horl2atl6n.
<br />Noma cure Data
<br />20. NO. Or
<br />CONTANVERS
<br />an. VOLUME
<br />Cu Ft
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<br />are In eg rp90e011e In ProPer rOo�ndmn for
<br />Irtylran�s Ottdat�xh4aord,/V to �y , 11>��om"
<br />4. U er E�hr /i 6�l r `` �l� rti—pn— r
<br />.4. TRANSPORTER 1 ADDRESS;
<br />Ete tiai:16, Inc. tidz is a
<br />"
<br />4136 1111.. Swift Ave
<br />rranno,CA 43722
<br />1 t RANSPORTER CERTIFICATION; Receipt or waste ae described arae.
<br />Rr rrrvr>s NaM �' e -y? e.'V Tu rra. — sl�tatwe
<br />5. INTERMEDIATE HANDLER 2 /TRANSPORTER 2 ADDRE6 ,:
<br />lvq E-7.17
<br />Date it , q/
<br />Rhone S: (68,9)275-2122
<br />AW[oe l® Permit Nunra;
<br />flaulac 3400
<br />Date . 70 f/1 -
<br />Y, 1
<br />1'APP&Able Permli N{utt4srs:
<br />S
<br />WiE1RA8EDIATE HANDLER /TRANSPORTER CERTIFICATION: Rewlil of maccal waete ee d@w1bed ebov46
<br />Prtnt/We Name f3lgnah,re oat
<br />s 6. INTERMEDIATE HANDLER 3 /TRANSPORTER 3 AODREGS: phone A:
<br />i
<br />Applicable Permit Nurnberg:
<br />E w INTERMEDIATE HANDLER /TRANWORTER CIE I TIFICATION: Rooatph of medical weals as descr W above.
<br />' Prlrlfljpe Name Signature Date
<br />T. DISCREPANCY INDICATION
<br />i y"
<br />IENT FACILITY: I certify that I have been authorized by the applIbable stats agency to accept untreated medical wastes and that! have
<br />the abouts indicated wastes in accordance with the requirement outlined in that aut horl2atl6n.
<br />Noma cure Data
<br />
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