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m MCWI4 atG inowrinu rvnm mumu <br /> e** Sterkyder Int CASE OF EMERGENCY CONT aC 1AMW STAN w-1 <br /> ®." ' .' ' noute : 301 - 16 Customet W. 21132 MDEMOA85N <br /> I.Generatoes Name,Address and Telephone Number <br /> AIM <br /> EUSPMUN MPE CM GE <br /> 5320 CAMIMIll CM <br /> STOCKTI01111, CA 95210 <br /> (209) 473-3004 12/1/201( <br /> CUSTOMMtNOWER 6039969-002 GOURA10in REGISTRMMo <br /> 2a. N OF WASTE 21L CONTAINERTYPE 2C.NO.OF 20. VOLUME <br /> CONTAINERS <br /> UMI RepWid Meftel V401c n.n.s - 90 sal Tub (V-o) (12 cu ft)6.z PON C <br /> 62,P I ReCu l MedlCM waste,r1.03-, 9 - 37 ] (810) (4.9 Cu tt) C <br /> C N PGII Regulated .".0.&' "14 - 44 Gal (Bi*) (5.9 CU ft) C <br /> UN M Regolow Medical .nes., 1 — 20 sal (bio) (2.7 cu 't:�) <br /> C C <br /> V UN331,Repisiod MOW WMIL n.os.. TB1S — 20 G&2 Tub (Path) (2.7 cu ft) <br /> C 62,PGII C <br /> 5 UN3291 ROW90d Medical waft A.G.L. TY15 — 20 6*2 Tub Memo) (2.T cu <br /> 62,PGIi C <br /> UNMi.RegWated Medical Waft n.cs., <br /> 6.8.PGII L: <br /> UN3291,Rogubw Memal wash.4.04, <br /> 6.2,PGII C <br /> Phalmaccutlical waste <br /> 3. es on:11 hereby deciam that the conwft of tide consigrtmentars tuby and accurabily T <br /> described ab*ve by ft per gypping nem.arld are classified.packapd.marked and labolled0acarded. <br /> are In at! In proper for rte <br /> ." <br /> IF ax t it All <br /> "y � l Name DaW 1 Z t I <br /> tr 4.TRANSPORTER I AWRESS:* 2: (559) 275 — 0 <br /> Steri le, Inc. Appr■able Permit Numbew <br /> 4135 West Swift Ave. El This is a auq shipment <br /> CL Fresno,Ca 93722 <br /> TRANSPORTER CERTIFICATION: ReoW of modicat wasto as describm abom. <br /> printiType Name ' V Dab <br /> C.INTERMEDIATE HANDLER 2/TRANSPORTER 2 ADDRESS: Phone 6 <br /> u <br /> . Applicalft Permit re: <br /> INTERMEDIATE HANDLER/TRANSPORTER of me0cal dem <br /> C <br /> PrIntirlype Name bate <br /> S.INTERMEDIATE HANDLER 3/TRANSPORTER 3 5: Ph 4P <br /> 5ApplicaMe Permit <br /> Numbers—, <br /> INTERMEDIATE HANDLER/TRANSPORTER C TION:R or as de emscribed m, <br /> P signattire hate <br /> 7.DISCREPANCY INDICATION <br /> f <br /> NeM W Loft,UT <br /> aJA Designated F 88. aC.Allamsto Fartp: ata.Aftwwda Facift <br /> ShvidVide Inc-Aulodm i Inch► Iraq <br /> 4135 W.SWIFTAVE 9d NORTH I IWVWW 1345 DOOM COO Sba G 2775 E 2M STREET <br /> O.CA WM NORTH SALT LAKE CITY, Son CA t VERNON.CA SM <br /> (09)276-03% ( I) .t (51 -1781 t KIM <br /> - <br /> TS311.75106125VI 91 .12.115 <br /> DALE ANF..O;-- <br /> it TREATMENT FACILITY.I certify that!haw been aullhorized by the applicaNe state agency to ampt untreated m a crical wastes and that i have <br /> received the above indicated wastes In accordance with the requirement outlined In that authorization. <br /> Printflype Name DEC 0 12010 haft <br /> VIP 3� <br />