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IN CASE%! wia 8300 ZTA Mm6ritim-am <br /> 1 Generator's Name,Address and UAW 0 <br /> ATTU: Sally Rrtryou D! <br /> j.3 <br /> 537 EAST VULWN alefiZ.&T SERUIc.1, DOE S'V'11?;S0413 AN <br /> 01111JER 111: Not <br /> - <br /> ----- - <br /> Ch 0.,.204 5- - -- --------- --- <br /> i• BQFRUQNl1UB <br /> TOM COLLECItil' 2 <br /> 101fit.001.0; It,guo LV <br /> 0glialEg 1914 MCC 1014 <br /> 2A,DESCRIP71ON OF WASTE 28. ............C........^ <br /> ..... ................ 20, NO.OF 20, VOLUME <br /> U=311,Requived Ma6z waste.nx.s.. TB57 90 ("1 U0L COUTAMERS <br /> 612,Pall Sagmevico"I 1UP0 DIV <br /> UN3291,Aeaul&d AlIddical Waste.mm" T940. 11 12.7 11-990 <br /> 6.2,PG)1 - rm 44 tal CI 1 2 <br /> .... ........... ....... <br /> UN3291.Rquisied Madiud waste,110 U BEL KILM UUMER I <br /> 1 —Ga L . Cu F1 <br /> --------- <br /> UN3'.10,Regolatev WdIcal Twas—m—n—.o.5., --70" 2 Cu R <br /> 6.2,Pell STV Ou Ft <br /> I UN3291.R4ulatad Modlc4ll waslar 7615 20 Gal MOE <br /> C 6.2,Poll <br /> i R --- - — 1011 4,1 Gal job,'01a). Cl 127 Ib Cu Fil <br /> a--1 <br /> po i Asquirmd miCA <br /> Cu F1 <br /> UN3291 Rualmomwicalwasle'n.U.S.. <br /> 62,Poll <br /> UN3291 Rquipled Medical WOBLe,n.u.s., Ralh. 1101larl <br /> 6.2,PGI! <br /> i,fiE"KCq- week 14 <br /> REX'NIC01 jiaf Ou 11, <br /> CISIONER GERUICE: <br /> [hillk qtw for ehoulng SterloWte4Ou FtL <br /> GailleratorV CartiffeAllon;"I hureDy dedere that it*wntmit TOTALS 1;0,1 Cu Ft. <br /> described above by the proper ah0ping name,ano arociail-jioei <br /> ale In&!I respeott;in proper owd) <br /> 177 <br /> X PrintodrRmtd Name <br /> 4."ANtporrEI'l� ADDU38: We sp <br /> tetrlfay('I*�A rrAq Th iis UgF9L SJUPSGh <br /> 413S wobt, swift. Ave. B <br /> TRANSPORTAgR reERTIFICATION:risi6ipt of mr.4mi waste as dwrimo RDOW. <br /> r <br /> FIIF)VTYP*Narno <br /> Sig D410 <br /> L INTERMEDIATE KANDLER 2 f719ANSPOAUR 2 xpoRESS; Flnolio <br /> Applimble Parma Numb"; <br /> INTERMEDIATE HANDLER/TRANSPORTER CERTIFICATION:Recroipi of modloul waste as described t4br.w-. <br /> Pr'nVI*yVa'Nhn-q Signatufo <br /> 0-INTFRkIEDIALTIF HANDUEF1 3 ITRANSPORTER 3 ADDRESS: Phom t <br /> Applv3able Pareril Nwribors- <br /> IAXWD3,l2R I TRANSPORTER CERTIFIOA-1711ON: Receipt of mud cal waste as casodbed above. <br /> Nam* Dills <br /> 7,DISCREPANCY INIAGATION <br /> Az <br /> II&Designattedd Vacillil a,—)rj—Ai"1WiW1FsdIky: OM Alicroultv FudlRyz m marnato Fami, <br /> ­9t6ftdO Ill"IC-AUtQK'JA1A9 milm-tiKkiliffullm Im'ALft4&V6 <br /> 4136 W.SV01AVE 1406 <br /> IW.VWST 1345 0"Sb C 2M 9 2VIN—81"REET <br /> FRE-SWO'CA 93722 NC t SALT LAKE CITY.OT SmLeivagiza,CA 94577 VEMON,CA 90013 <br /> (969)279- 1121 (ea 1)on- 1565 (ate)-So-2177 0"')362-m <br /> TS41181`22 26 <br /> TREATMENT FACILITY: I oj'tliy that I have been authorIxed by the apoicetble state agency to accept untreated medical was'166 and that I havc- <br /> received the above Irdicated wastes in accordance with the requireman! >ulfinod In that alltharlZiltlion, <br /> PrInVrypo Name Date <br /> raetyllara�adtei�rWu to-tam hitt TREATMeW FAOL.Iyy <br /> L0/90 39Vd 3 3113lVS V1 0 8T:VT TT03/LT/90 <br />