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ROU' <br /> 41• <br /> Steric <br /> clea <br /> �0 el <br /> HALARDUUS MATERIAL <br /> DOCUMENT NO 5 , �v L B �m, <br /> 1111111111111,111Jill lllillllll DATE. SHIPPING OG;UMENT <br /> B I O T+R A C K- ACCOk EMERGENCY PHUNE 1-800-234-0051 <br /> �7Medical Waste Tracking System ACCOUNT A: 611594K.QO2 <br /> � 1MANTE CA I ARE 8 HhHA6 <br /> REGULAMRY # <br /> ti <br /> DRF\ SHIPPING DACE 8/9/2004 11:02:41 AM <br /> Name ARS DRIVER ID: THI <br /> s <br /> SHIPPING DOCUMENT k MDFR001LL6 i <br /> Address RFn1LaTFo MFDr.AI_ NgTE <br /> = <br /> City State Zip <br /> 9E 5_ 57 6,2 UN3291 PG11 <br /> S rler nc foTAL CiI_iiCIFD r,DNIAINERS �2 <br /> Phone __ _ TUTAi JOLUME 11.8 CUBIC Cr <br /> i:OUE iYPi_ t1*UUt IYPF ;:DDE y c <br /> AUTOCLAVABLE ANAST 4 i alai , IOl4 <br /> hl; 15 IU I:LNI ItY :H.4T THE <br /> Cont Quantity Cont Quantity Cont AUDUL NAHI-0 HAILiL'+L;; ARE PRDPERL;" <br /> Type PIU Del Type P1U' Del ' Type CLASS&IF,D, UESLHIHF_U, PACKAGED, <br /> _-• HARKED ANDI.ADELED, AND ARE INPROPERT857 SH05 T815CONOI IIUN FUR IRANSPUHTAI IUN ACCORDING <br /> TO INE APPL!CAbfr REGULATIONS OF THE <br /> TB49 SH06 &_ TY15 ULPAHiMENI OF tRANSPURTATION, <br /> TB35 SH07 SH 12' <br /> T624 SH08 SH 1:4 <br /> TB21 , SH09 SH2 <br /> TB14 SH11 F014 PRINT NAME <br /> TB06 SH59 BG9 <br /> ST75 i 5H60 BP <br /> ST32' SH91 1 SHZ <br /> SH03, <br /> BX99 SG2 AUTHORIZED SIGNATURE 3 <br /> SH04 SH99 I SG5 <br /> 6ENERMOR CERTIFICATIOR:This is to certify,that the above-named materials are properly,classified, described, packaged, 9.1A na )r <br /> transportation according to the applicable regulations of the Department of Transportation. <br /> n <br /> �.s <br /> ' Print.Name _Generatofs.,Signature Date <br /> REGULATED <br /> 4 <br /> FG57 RX10 <br /> XM99 RX27 <br /> TD86 RX99 <br /> RX33 <br /> 777—- <br /> a! Stericycle, Inc. ❑Stericycle, Inc. ❑Stericycle, Inc. <br /> 28161 N.Keith Dr. 28161.N.Keith Dr. 11875`Whiterock Road <br /> Lake Forest,IL.60045 Lake Forest, IL 60045 Rancho Cordova,CA 95742 <br /> (323)362-3000%, (323)362-3000 (916)985-5506 <br /> Haz.Hauler.Riag.#3400> Haz.Hauler.Reg.#3400; MWTS Permit#34-6-P <br /> X X <br /> X <br /> Authorized Signature Date Authorized Signature Date initial Date Received <br /> a , <br /> NERATIUN:WASTE* <br /> A iatw tc w i. y . DESTINATION <br /> { <br /> ' — <br /> StericycleInc. F7, Stericycle, Inc.Stericycie, inc. u 90 North 1100`Nest <br /> 4135 W.Swift avenue 1345 Doolittle Drive,Suite C North Salt Lake, JT 34054= <br /> =resno, CA 93722 San Leandro. CA 9457, <br /> 559) 275 0992 ::10)636-9502 8101 If 936-1555 <br /> .1WTF Permit 1410-a3-P MWTS Permit "19-23-P ::ass V incineration , <br /> -reatment �y,autoclavtng,: MWTF Permit =37 18.72 . `� — 'Qrmlt*91 02 <br /> "AMTS---1 3 P. � 37_5 P � ^2_ ut ,nze,. �zt t. <br /> ' h'1 n int;, ,rp. `�n p r <br /> J <br />