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MEDICAL WASTE TRACKING FORM NUMBER <br />i°4 ♦ STANDARD MANIFEST 401-to•08STD <br />p 0 StGVICYCIG IN CASE OF EMERGENCY CONTACT: CREMTREO 1.800.424.9300 <br />'e' netenreyreopdr.Rrau,rsrlt' Routs 0; 124 - 16 CUST041ER NO, ?1132 MUR00HB136 <br />1. Generator's Name, Address and Telephone Number, <br />ATTN.Frank Juarez <br />> LMlR}1,V.NFT CARE CFNTER <br />6940 PACUIC AVV <br />STOCKTON, CA 9ra207- 2602 <br />(209) 477-4817 <br />12/30/2015 <br />Facility: <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 /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />the been authorized by the applicable state agency to accept untreated medical wastes and that 1 have- <br />;cordance with the requirement outimed In that authorization. <br />—cu TIV. <br />Date <br />