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ME=AL HASTE <br />Ste e' IN CASE OF EMERGENCY CONTACT: CNEMTREC 140424430 Sr o r FEW C10 -1046-M <br />Gra02W 3Q CUSTOMER Na 21132 MDZ'• <br />1. Generstor°s Name, Address and Telephone Number <br />ATTN: ill <br />G4 UVIEG E'n M - 569 <br />4545 SMIXT COUM <br />3Tt'Jt.MM, CA 95207 <br />CLVTONO NWASM ane CIC—nn-2 <br />3 Generatoft Certitkation-.1 hereby declare drat the contents of dit muignoW are bjVyr and a=m* <br />deserbW above by the proper dupphV row. and are closeted, Packaged, marked and tabeNadtplacarded, and LIM <br />are in aft respects in props condition for transport swording to appikabte hiternatiorW and national governmental replel <br />i _ , Narne -11 re <br />4. TRANSPORTER 7 ADDRESS: <br />Stericylcle, Inc. 0 This is h <br />4135 Best Mft Ave. <br />Fresno, Ca 93722 <br />TRANSPORTER CERTIRCATIION: Re cavt at meow ,Rasta as described above <br />Nam r Signature <br />5. INTERMEDIATE HANDLER 2 / TRANSPORTER 2 ADDRESS: <br />Phone if (569)27t4121 <br />121 <br />3n14pp eawsPam* <br />Hauler Reg# 3400 �( <br />.Ir z I <br />Data <br />Perone f+i <br />AppticWo Pennit Ntsnbars: <br />1WITIMMEWTE HANDLER /TRANSPORTER CEFMFICAMON: Receipt of medical waste as do=NW above. <br />Prinirrype Name Signature Data <br />8. WERIMEOM KV=M 3 / TRANSPORTER 3 ADDRESS: N: <br />i <br />ORIGINAL <br />