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SrANDAPP MANIOL-S(001-1'-'NW0 <br /> Me sterilcycle' IN CASE OF'SMEA4 <br /> 0.0 ivA,cvq npl%fw*^'mg WON M.DIFTMAYRR <br /> i.Generator's Noma,AddreSS and TallePhW$Number ......... .. IM KK if <br /> 4d Ol, ATM.- flally Reye DOD <br /> LA SAILIi-IfIrE C:0KV1 111vL11BWT <br /> 53,? EMT F ULTOW STSMET RiUll'I <br /> STOCK EON, CA $5204 11GCW9I 4 6081746-916 <br /> La Welts <br /> SERUICE BRIE1 <br /> DRIER 10 Ark <br /> CV$T0MER NUMMER 6081745-CIS i iF W UT,Viu"i 20 NO,Of 2U. V40LLIME <br /> 2A.DF.GCRlPTIONW%Wo7FF-1 I MILE01F.5 q I CiiNTAINERS <br /> LIN2291,R60013ted Medical Waste, CU 1`1 <br /> 62 pG11 90 rias Tub 10IRL QQLQK; 23,EUP I CU pt. <br /> lltflilkk� F614 WXWI lidli <br /> UN3291 11804lattic MildiCal WWO.[M).­ Tub QUOU IDA <br /> I T11 �441 I ou F1 <br /> 612' -A <br /> UN <br /> I:��Tayjr - 'i" GAI. Tub ---------------------- Cu pl. <br /> ,2!291 Regultited Medical Wisit%.M.0 1111111, <br /> poll My CF <br /> UN3U1.jj�Ze_dfA;ic_alWaste,P.o.,. Is7]L - 20 Ga I Tlub f! <br /> 0.2,PG11 <br /> IBj;1 4.16x1 lub(111111- U <br /> U1441.Aiigulaled Medical Wage, - 20 dal TUU ------— <br /> ..__• <br /> --- <br /> -- -- <br /> B.2.PGII. <br /> UM211 Regulated rAUdiC2lW1tie,11-Q-,'.. <br /> nO Ga:L Tub (Chaocw) (r•'r at.; it) F! <br /> owsi.5jimed Cu Vt. <br /> 61 PG 0 <br /> UNBW <br /> 6.2.Plil! Cu F... <br /> Pki-irweekAtidal <br /> 3.Genamor's C#rfltloatlorr'I hunaby 4clafe than t1r.coyjera a of this consigniront are fully and avcmatT OTACu Ft. <br /> LS 00, <br /> desofitiocl ei0ovia by trie proper oNppirKj name,and ure Cla"Iflaj,Packaged,marIxed and lai:ielisd;plU:cirdt-d'and <br /> are-n kill riiarecis in pfol),ar condition for trariaport 800ording to applicable Inlarnational,and national govorm.v"nial iiagublioria, <br /> We <br /> PrintodMped Nam 6' nature Dam L <br /> x 7-' Ptsneh': (!�.iro <br /> 4,TRANSPO!RTCR I ADDRESS: )i_ns-11e:] <br /> St9X-jr,,V,VjkL;,, rinci.. 'Mix La a Thr-oulh. ShiPmArIlt ApplicausPeru-IINUMDO'M <br /> 41136 Vk".Nt Swi:ft' <br /> rresono,Ca 53?22 <br /> TRANSPORTER CERTIFICATION- RacL*t or nvocat-Atitate,as d"CdW shave. <br /> . ........... <br /> Pfinl/Ty <br /> pra Nam® ...... <br /> INTERMEDIATE_AAN5LEA 2/TRANIPPORTBA 9 ADDRESS: Pilo lo 4: <br /> Appli,AW Pei inif Nuait)ws: <br /> INTERMEDIATE HANDLER/TRANSPORTER CERTIFICATION: Fleoelpt of medical manta,as dwuribad AboW. <br /> PrinVIYO NanIO Sigriatura Oats <br /> G.INTEFIMEDIAITHAN UV13/TRAN.5 Pt WER 2 ADDRESS: Phont;0; <br /> Anpic3hle Permit NLFnbo.-w. <br /> [INTERMEDIATE HANDLER/TRANSPORTER CERTIFICATION:PmGc%pj ctf.To,,dinal zA;6"Orbed abovo. <br /> X <br /> Piiint/rypa Hams — <br /> _71-11011EPAN0 VDICATION &0 Lake,UT <br /> Stre <br /> 717_1 of,',A'utcmmut,Fu,'illty: <br /> I <br /> DwIfIriated FacillAy 1 80.Altrjrrwkc ftclUty: stall de trW.4NUtDCWV@ 'aaikyds)nC-AtAOCJft4fS A. <br /> Z <br /> stmiqde Irp>o0coe Inc-AUtCd8VQ E <br /> 1136 W SWPI'AVE 90 NORTH I IM VeST i a Cstve ft C Z776 ?131"1-0 MWT <br /> FREWO,CA 93721 NOWH SWT LAKE OTY,UT Swi Usaricn,CA $4677 VERNON,CA X1523 <br /> (659)275. 1121 (801)9'36- (55S (05 to)662-T 17 7 (3231362.31 0 <br /> TWOST22 3A-448-JA-3pa <br /> T REA'FMENT FACILITY:I certify that I heve been authorized by the appficabie SWA&9911C01)aooept untreated medical wastes and that I have <br /> authorization. <br /> received the above Indicztod wastes in acicordanoa with the requirement outlined ia that authoi Date <br /> ViiiiiiType Narne <br /> Ti�iXVAENT FACILITY <br /> L0160 39Vd 3 3113lVS VI 0 8T:VT 1103/LT/90 <br />