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209+463+6910 GOLDEN LlVONGdfiNA11kd1k A 00:09 P.M. 06-09-2011 8/8 <br /> To:Tom Gantt page s of s 2011-05.17 09:23:40 GMT-06: 18663334165 From:Bell Team <br /> �•® MEDICAL WASTE TRACIaNQ FORM NUMBER I <br /> ®®�® stedcYc Q' IN CASE OF EMEROLWY CONTACT:CNBMEC 1 09ursee sTD <br /> • ft-ftaep`e�� CUSTOMA NO.21 <br /> In-6— as 100 - 12 C408-00SC-20 <br /> 1332 <br /> 1. 1's Nems,Address T ale N <br /> T s ¢570 Il I 1� I I , <br /> 2740 11 CALIMMA ST. <br /> SIOMMI, Ch 9S204 <br /> i <br /> i • <br /> 20L DESCROPTION OF WASTE CONTAINER TY "mop :a VOUAU <br /> ICUM1191a Reodood t OOM WMIs,e e.a, CONTARWERS- <br /> ed .po w Fb. <br /> at �Ne <br /> 7949 - 37 Gal tab 111101 14.9 eat ft) Cu FL <br /> I <br /> 0 <br /> at. tllpeol,a os, <br /> 44 Gal Tub 810 5.9 ecu tt) p <br /> in <br /> trod real - 20 till rub`tato) (2.7 cu tEt) w FL <br /> f12.PBil no <br /> 9'e15 - 20 4ia2 Tub `Bath} (2.7 cu !t) gg FL <br /> I u�wi ' Mhae.n o <br /> - ® Fe <br /> @.2.1+811 ii� '• <br /> Qu 5.2.I.npetold Medal Waite,"A R' I <br /> Cu FL <br /> Cu Ff. <br /> �"''' <br /> �. :I rrrray dedme goCm 01 go am fiat SW telt TOTAI.b'® "� +► .' cu <br /> desalbed ebae ft pamper an <br /> rams, d are clasAad. mads d and ed,mtd <br /> I aro b1 reapeets proper to ere Dna.° <br /> 'Prbgod/T Nam. g')�' Co►g2- —onto <br /> 4.TRANSPORTER 1 ADDRESS: a: <br /> Steri I . 275 — 0 <br /> 1 cycle, Inc. <br /> 4335 hest Swift Ave. This Ls a Through Shipment <br /> FIL res o Ca 93722 <br /> 1 TF 2/TRANSPORTER 2 SS: Phone e: <br /> � : Parmk <br /> li #MRMWATENANDUSITRAMPOMRCERMCATM:PaoMofneckaiwamasdmbwom. <br /> Nurse RSA ! <br /> i <br /> IL INTERMEMTE 3/TRANSPORTER 3 ADORES& p e <br /> Appleable Ferran Numbers: <br /> iOffEMEMTE HANDLER/TPANSPORTER CERTIFMATION:PAGW or medical wale as dow4bed above. <br /> P"TYPO Norms pr ws Gate <br /> Y.01111CREPANCY INDICATION <br /> d gm 2 Lab <br /> i <br /> aC. Paeally 81).AawnNe Fader: <br /> 4135 W FTAVE 90 N 1100 WEST 1345 8o C 2776 2M STRWr <br /> e Ir1c A Ina a Inc <br /> FRESNO.CA 93722 NOR7H SALT LAKE MY,1L T Sen Lo CA 7 ON CA <br /> j (tom 275-0994 (at)as-tus (sail)"2-1781 (323) 362- <br /> MUM&MRSM TSOOST22 CJMV hwWwation Pwff=rl�-W P-6,P-115 <br /> Tt /1 ENT FACILITY:I certify that I have been auihwlzed by the applicable sUe agency to accept untreated 11 adr.at wastes and that I have <br /> Indicated wastes in accOrdanw with the req armed in that&WWl=tI0rL <br /> PrbH/T Nerve tees <br /> noeeseuae <br />