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-- -- - MEDICAL WASTE TRACKING FORM NUMBER <br />4 Q $tGY [C ICi@` IN CASE OF EMERGENCY CCNTACT: CHEhiTREC 1.800.424-9300 STANDARD MANIFEST 001.10 DB STD <br />"_' ►,mxu y►ro,tr.e All Rothe #.' 122 - 8 CUSTOMER NO, 21132 NEDFROOHA4 8 <br />I <br />1. Generator's Name, Address and Telephone Number <br />ATTN:V ank Juarez <br />MriMHAV.l N CARL CENTM- <br />69410 40 PACIFXC AVE <br />STOCKTONr CA 95207-• 2602 <br />(209) 477-4817 <br />CUST01414 NUMBER 6090854-001 GENMATOR•e REGISTRATION A <br />1/201.5 <br />2A. DUSORIPTION OFIYASTE <br />20. CONTAiNERTYPE <br />2C. NO. OF <br />CONTAINERS <br />2D. VOLUME <br />Iu}N323i Regulated hiedicat Waste, 0.0s, ffl2l) t� <br />TE05 — 40 Gal Tub (Bio) (5.3 au ft) <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />21 <br />DEC 21 201501 -, <br />TF? AT 111 T FACILITY: I certify that#[ hav <br />ree ive Ji£f� a'bn(oVoeindicated wastes In ac <br />been authorized by the applloabte state agency to accept untreated medical wastes and that I have <br />with the requirement outlined In that authorization. <br />-' �+usU <br />trdance <br />Prin pe Nemd"� <br />Sgnature <br />Date <br />4? <br />t`+ <br />It vnruuvnr.. t <br />