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+!• StarkycW IN CASE OF EMERCERCY courAct CHEMTREc' -_.----"STA--�.®. ---- t-t®.,.... .....v.. <br /> ®®* fto ow to f: 301 - 8 CUSTOMER NIX 21132 HDFROCIAL100 <br /> 1. or%Nam,Address and TWephone Number <br /> AT": <br /> Wasmajo Win cm czym <br /> 5320 CAMIGWI11 aR <br /> STocrm, CA 9521.0 <br /> (209) 473-3004 4/27/2011 <br /> cmmmmom 6039969-002 a <br /> 2A.OMROYTION OF WASTE 2E. CONTAINERTYPE 2C.NO,of 2D. VOLUME <br /> CONTAINERS <br /> E2.PGII �e�` 7 — 90 Gal 'tub (Frio) (12 cu ft) Cu Ft <br /> nes, 9 37 Gal (Bio) (4.4 cu tt) 'Z 9 <br /> — Gu fit <br /> 6.2.PGH ReFlm Madkal Waftus', T814 — 44 Dal 'tub(Bio) (5.9 cu ft) Cu Ft <br /> UlmBl2 PCt °t 1 — 20 Tub(vio) t2.1 cu ft) Cu A <br /> W 1110291.R .nos. 2815 - 20 Gal Tub (Path) 42.7 cu ft) <br /> 6.2,PGII Cu Ft <br /> 81 Z. <br /> dAt. n.os„ '1"Y15 - 20 sal ?ids (�chemcr) (2.7 cu ft) CU Ft <br /> s 2.PG ulated u nog, cu Pt <br /> f.Reputim m ,na.s.. <br /> 6.22,Plitt Cu Ft <br /> armaceuhical Naafis CrF <br /> a, fl :M hereby dedare mat the contents of trds consignment are ft*and O=Nately TOTALS -2. Goa Ft <br /> described above by the proper ng name,and are and iabstiqwpiecardetL and <br /> are In as respects In proper co far a=mong to applicable Internationat and national gover ental <br /> r <br /> I _ !Prtnfadit Nash S 3i ours ate dIc (� <br /> 4.TRANSPORTER 1 ADDRESS: <br /> (659)275-1122 <br /> tW <br /> Stericycle, Inn. This is a Thp4gh""Vhipment Applicable Permit Numbers: <br /> 4135 Beat Mft Ave_ AauleT Beg# 3400 <br /> Fresno,Ca 93722 <br /> aTRANSPOIll CERMRCA71ON:Receipt of m above. <br /> P M. Date <br /> 27 tf <br /> SWMRMEDIATE HANDLER2/TRANSPORTER 2ADDRESS-. r <br /> �1-"� t rss: <br /> RMIEGtATE 4iAN PLER/TRANSPORTER CE43TIFICA71dN:Receipt of med1calwasteas descdwd <br /> above. <br /> Prfrit/Type Name Signature Date <br /> LU 6,INTERMEDWE KANDLER 3/TRANSPORTER 3 S: Phoneo; <br /> ApplicabIe Parmit Nwnbew. <br /> INTERMEDIATE HANDLER/TRANSPORTER FICATION:Receipt of medical waste as described above. <br /> PdnVType Name S111nalm Date <br /> F.DISCREPANCY INDICATION <br /> r ouftto: Worth Saft Lake,UT <br /> 86 eC F e1r. W.Aftemsto F <br /> J <br /> Inc-AuWdm Inc-AIndneralbn Stericycle InC-AUtOdaW SWdcy&Inc-Auftdovet <br /> 4 <br /> 4135WSWFTAVE 90 N 110OVYEST 1345 DOOM DdW SW C 2776 E <br /> FRESNO.CA 93722 140MM SALT LAKE CITY.UT San Lealfro.CA 94577 VERNON,CA 91=11 <br /> 275. 1121 (act)mis-1 (SIO)SO-2177 <br /> i ISAWM TSW"Skosrls 26 <br /> # ADAUEMMORMVLWINAVED <br /> TREATMENT FACILITY.I certify that I have been auModzed by itre applicattie stale agency to accept untreated metrical wastes and that I have <br /> 61 1 received t*"1PcfiWed wastes in accords=with the requinanuirit outlined In that auftrization. <br /> Witt <br /> Nam —Signature Date <br /> 4384133 <br />