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82-579 Fleming Way <br /> Suite F Tel. 760.347.4422 <br /> Indio, CA 92201 Fax. 760.406.5975 <br /> NATIONAL <br /> GREE <br /> GAS <br /> For Generations to Come <br /> F-1For <br /> NO: <br /> WASIECLASS N3291 Ca►ifornia MEDICAL WASTE TRACKING DOCUMENT <br /> PG.It Medical Waste Emergency telephone number:877.4124422 <br /> Generator Information This is to certify that the materials described below are property classified, <br /> packaged,marked and labeled and are in proper condition for <br /> transportation in accordance with the applicable regulations of the <br /> United States Department of Transportation. <br /> Q _ <br /> Z r`<' NAME OF COMPANY REPRESENTATIVE(Print) <br /> SIGNATURE OF REPRESENTATIVE <br /> f' <br /> '' 4-, <br /> DATE <br /> Type of Waste: ❑ Bio/Sharps ❑ Trace-Chemo ❑ Pathologi I 0-Pharmaceutical Other <br /> Number of containers collected Est. eight Actual Net Wt <br /> 18 G 32 G 38 G 48 G 9 G OTHE <br /> Comments <br /> Deputy Weighmaster's Intials <br /> ❑Other ❑OTHER: <br /> National Green Gas,LLC <br /> 82-579 Fleming Way, NAME OFCOMPANYREP�RESENT6TIVE(Pnnt) <br /> CL <br /> o Suite ',' >, ' , ,,j <br /> Indio, CA 92201 - <br /> Z <br /> Tel: 760.347.4422 SIGNATURE OF REPRESENTATIVE <br /> e _ <br /> Transporter i, z`+ <br /> Registration#:6031 <br /> Date of Trans ortation <br /> OF-1 ❑ ❑OTHER: <br /> National Green Gas,LLC National Green Gas,LLC <br /> 82-579 Fleming Way, 16-457 Avenue 241/2 NA ME OFCOMPA NYREPRESEN-TA TIVE(Print) <br /> co Suite F Chowchilla, CA 93610 <br /> w Indio CA 92201 TS-7 <br /> z <br /> Tel: 760.347.4422 SIGNATURE OF REPRESENTATIVE <br /> TS/OST-99 <br /> Ie Date Received in Transfer <br /> ❑ ❑Other ❑OTHER: CERTIFICATE OF DISTRUCTION <br /> The signature below certifies the above documented waste was received, <br /> National Green Gas,LLC treated and disposed of in accordance with all local,State and Federal <br /> 1-- 82-579 Fleming Way, Regulations and following all conditions within our permit,on dates <br /> cs Suite documented. <br /> Indio, CA 92201 <br /> Tek 760.347.4422 <br /> TS/OST-99 <br /> Treatment Type:Ozonation NAME OF COMPANY REPRESENTATIVE(Print) <br /> W <br /> SIGNATURE OF REPRESENTATIVE <br /> i <br /> DATE RECEIVED Date of Treatment <br />