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• KhWGAL WAU I ft TRACKWO FOM MUMBE <br /> +i S U1 tC &T -t <br /> V #s 301 - 13 2 NDFROOAFKH <br /> 1,Ge is Nairle,Address and TeWphone lftrftw <br /> A <br /> mrsmals Wn am CMM <br /> 5320 <br /> STOCrM, CA 95210 <br /> (209) 473-3004 1/14/2011 <br /> 6039969-002 Gallaxamar <br /> 2A. OF WASTE 21L CONTAINE011TWEW—"a of 21xVOLME <br /> tMMReoplated Medical ,nes,, 7 - 90 (Die)®) (12 cu >:t) COM <br /> ADIEM <br /> 62,X11 Cee <br /> sa,vsn &Wcd nos. 4 - 37 1 o) (4.9 cu ft) 3 i Cu <br /> CC 6.z. I d n-0-S, 14 - 44 tial teioi (5.9 �tt) Cu <br /> LWWo cos <br /> 62.P6Et. n as, - Gr <br /> Z 8.2,PGII n a 5 - 20 teal (Path) (2.7 CU ft) Cu <br /> t3 110= PAPER go@ 62,Psii "-Ss TnS - 20 Gal (Chemo) 12.7 Cu ft) <br /> Cu <br /> 62,PPIl nos„ Cu <br /> 62,1,611 .nos Cu <br /> PR►A ceuttcal eta <br /> 3.Generstoft Cefflicadon:9 herr dsdare dW the OMWft of tf"c=dWvnwt am fully and T <br /> described above W dte Loper sfil$ ng r�rne,and are and ,and <br /> are in all resp in proper oono; n far racoorcum to applicable Ygernational and nabonal governments!reguladorW <br /> IV <br /> 4.TRANSPORTER f if: (559) 275 - 0 <br /> StericyCle, Ines. <br /> c� 'et3. e k Numbers: <br /> 4135 t $t A <br /> Freelno,Ca 93722 This is c Shipment <br /> L2 1 RE ' :R of medical as described <br /> Print/Type Name `��. ' • • — 1' lt /t <br /> S INTERMEMATE HANDLER 2/TRANSPORTER 2 ESS: Phone t <br /> i <br /> Applicable Numbers: <br /> t <br /> INTERMEDIATE N /TRANSPORTER CERTIFICATION: al medical wage as descilbed above. <br /> Ptkt Data <br /> i IL INTERMEDIATE HANDLER 3/TRANSPORTER 3ADDRESS- phone It: <br /> '8Applicable PerrrdlN es: <br /> INTERMEDIATE HANDLER/TRANSPORTER CA of medical waste as described above. <br /> ' Name Data <br /> 7.DISCREFANCY INOWATION <br /> • DealrWrted Facilli r BC. Kyr 90.Alternate F <br /> Inc-Adm*m SWd <br /> Int: Inc <br /> 4135 W.SWFT+ AVE yS`fp Iii 1 C E <br /> tJe 17 ! LAKE MY.UT <br /> SM Lawift.CA 94M VERNON.Ok SM <br /> ( x75-O&W (eel)an-1 (5111111)SU-t781 1 <br /> i 1. 5 TSKSM ChWVIndnW"PwnW9I-02eP-115 <br /> IWEANNEc tAVaRTIZ <br /> ED <br /> TREATMENT FACILITY:I cerWy that 1 have been auttwized by the appikable,state apncY to amept untreated that I ham <br /> ted wastes in accordanos whh.the regWrement outtined in that authorizaBon. <br /> Priv Name - tura Daft <br />