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3RA1.0 BEVERLY <br />02 07/03 08:10 FAX CIS!L AWTfC TACKINNG�I®QQG NT � OS <br />INTEGRAE RONMENTAL SYSTEMS <br />F4 Phone: l (800) 292-7837 or l (800) 2 WASTES 732-338 <br />Serving California... Oakland - San Francisco - Sacramcnto - Modesto - Fresno - Los Angeles - San Diego <br />NAME ........ ..•---•.................. .. <br />1=FVERLY MANCIR CONV HOSP <br />....................... <br />ADDRESS ............740 N CALIF; RNIA ST <br />................................................. <br />ADDRESS STO KTON CA <br />.................................................. . <br />ACCOUNT#.......--•--••-- 5800$ _...... <br />PHONE# .......................................................09 -456-3522- 0 <br />......................................... <br />O ITY REL D BY GENERATOR . ..... .................... I.... ...... ........... ......... <br />BIOHAZ SHARPS PATH CHEMO PHARMS <br />ONLY MEDICAL WASTE AS DEFINED BY LAW IS IN THESE CONTAINERS UNLESS AS <br />OTHERWISE SPECIFIED HERE. THEREARE NO HAZARDOUS OR RADIOACTIVE MATERI- <br />ALS INCLUDED IN THE CONTENTS. THIS WASTE WAS RELEASED TO THE PERMITTED <br />MEDICAL WASTE TRANSPORTER IDENTIFIED HEREIN. <br />2 °-T I5 44 Wertify that the foregoing is true & correct <br />"TRUCK KEY ;#40" <br />1%14 C�.:a: C+EaT/;EvRaE..............................-----------......... .......... ............. <br />�¢ye/ <br />Sig ra nfGener&r'sAafharMAgent Data Aetaased <br />LOU+ 1 + + + 1 MWIVIIIIII.Iq 311131 <br />TRANSPORTER: TREATMENT FACILITY: <br />n INTEGRATED ENVIRONMENTAL SYSTEMS INTEGRATED ENVIRONMENTAL SYSTEMS <br />499 HIGH STREET. OAKLAND CA 94601 PH: 510.261-1512 499 HIGH STREET, OAKLAND CA 94801 PH: 510-261.1512 <br />TRANSPORTER PERMIT #2028 EPA 10 #CAD -980890321 DHS PERMITS: #99-00069-P, 099-00070-P <br />Z.E.S. - 0AKL.k4l) <br />® X 499 F{i r�h Stre-:�t THE IDENTIFIED TRANSPORTER DELIVERED THE ABOVE DESCRIBED WASTE TO <br />Oakland, CA 94601 THIS MEDICAL WASTE TREATMENT FACILITY. AS DESCRIBED IT WAS ACCEPTABLE <br />FH;8002927837 Tl�ns Parmit202$ UNDER LAW AND CALIFORNIA'S DEPARTMENT OF HEALTH SERVICES <br />REGULATIONS. <br />EPA ICI # <br />�^�-:^'"►+yam, <br />PICKED UP DELIVERED QFf/�NTITY RECEIVED ...................................... <br /># of Barrels ,.-- <br /># of Boxes rc at s Autharaed Rpent .IL Receives <br /># of Other <br />TRANSFER STATION: ................ ..................................... <br />Date Shipped Out <br />ASTE I: VE <br />TRANSFDER <br />S ONNDOTHiSSDDOCUMIN�f. 0 r' 3 2 3 3 8 0 0 5 8 0 0 8 <br />....... ••................................. A.(3... <br />Siga (ere Treaperier'sAufhaflMAgent pate - <br />TRFATFAENT FACILITY ORIGINAL <br />