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®fSftrkyeW h _Oct <br /> -1 _ <br /> 1-GeneraWs N t� . d and Telephone Number M1011111111 <br /> S NG ON CARE CNN= <br /> 5320 r.Tp <br /> CA 95210 <br /> (2091 473-3004 3/1612013 <br /> 6t134a#;4--nn-7. <br /> ar <br /> 2A.DESCRIPTION OF WASTIE ZEL CONTAINERTYPE2C.UM OF 21L VOLUME <br /> =29 n.a� — (Vic) (l2 ou 1`t) CONTAINSFIS <br /> Cu F' <br /> 6E.2.PGS nos., 9 — 2 ®) (4.9 ft) 016 <br /> Cu R <br /> ® 62,ONn 4s., — O) (S.9 tett ) <br /> 4t, rtos., . <br /> Cu as <br /> ge 6.2.Psn Cu E_ <br /> w ,n.®.� - a 1$.T rt) <br /> W &Zaoai Cu P <br /> L%=1. .n.os., TY15 — 201 002 ( ) (2.7 cu ft)&z PrA <br /> Cu P <br /> 11111=1, n.os., <br /> n pmt <br /> F <br /> UN FSE. ,n.o s., <br /> Cu F <br /> Pharm utical <br /> gm r- <br /> 3 tim*1 hereby rn that the of mmt are and ALS '?.GP <br /> desmibed above by the Proper sh" ' name,and are G1�F <br /> are in as respeft In proper mrtion for ` kV to national natiaentad <br /> XX ! Narne_ 1 Ct V* waWre!QL64:2�� Date <br /> 3 f ff <br /> 4.TRANSPORTER $s Inc. Phone a: (5591 273 0 <br /> 4135 ftet. M ft Ave. Applicable PWmN Nwribew. <br /> a <br /> TRANSPORTER C FICA 1 :R of rr WW wasW as desolibed above. <br /> cc <br /> Pri /1, <br /> Name r V SiQnabure tate <br /> t3.INTERMEDIATE HANDLER 2/TRANSPORTER 2 ADDRESS: phone N: <br /> AppRceale Perm* re: <br /> INTERMEDIATE HANDLER/TRANSPORTER N: att i as <br /> — Print/type Name Si9nad►ra <br /> n 6.INTERMEDIATE HANDLER 3 t TRANSPORTER 3 ADDRESS: Phare N: <br /> �{ Apprmable Permit N rs: <br /> WTERMEMATE HAND /TRANSPORTER C FICATION:R9CW ot medw WarAs as . <br /> PfinYType N Date <br /> 7-7INDICATION CU <br /> n' 6 h go <br /> emd UT <br /> 89. &C. F r <br /> 3 4135 W. A N 11 W Dooms oft sw C 2MENT1487mr <br /> LAKE CrTY.UT Sm Learft,CA SW7 V80101,CA OW <br /> `_ , ( ( t) -tT Bt <br /> f 0) ®I <br /> T331r cum" <br /> 9 "ll" <br /> E DALE ARKS CqTIZ <br /> AVMCWrcD <br /> TREATMENT FACJL1TY.f certify that t have been authorized by the applicable state agency to accept untreated medical wastes and that t have <br /> recelvidA 40aififfisled wastes in accordance with the requiremenil outlined in that authorization. <br /> iAlntttype NPrt Date <br />