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'W'Jamnd Bomd-ed Inc MEDICAL WASTE TRACKING 1)(3CUMENT# <br /> 11258 mmarr-h street, suite C .8 <br /> Gar dm Grove,-CA 92841 <br /> 1300-7,00-3581 TAI Fme <br /> 900-472-5075 FfiY, MEDASEND <br /> 1. <br /> Balance Due: <br /> GENERATOR(Pick-up Lwstan) UENERKTOR I 5,HI;Pfp.(-7,RTjFjCATjo1q <br /> Sq.NV'A-:ui�TPU nib is tO CeMY th-9Z il MBrOldals identified.b�jipaz aF@ Pj;jS5jfzd.package?[, <br /> Wd coriditoz for accoTdibg,tb the <br /> 1-1 a7 C OlrA St <br /> PRINT NAN.J� TIME <br /> Y-qm 5pza aw, <br /> MUq3ROiTE-R -EGI3TRATION46146 G f Undez=-as ouly UN323 I Rqnla�d 3ioh*amdoA-.wzvLe as <br /> Meamend Biomedical 1nc d ed�7 UMPA, (—k Vfi,,,DOT,and COP14 qiR be xcp-pted by <br /> i me-AaNh it Medketd Riom.editaj, wa.-te wall act be accepted. <br /> Gardezi-Gmve, Ca 92 841 <br /> 14!�Cf-Tmsforlcta�qrr er;, ",hG'xrhiU CA SIGNAT URE DATE Vj <br /> Treatment Facility: <br /> D=elz Sharp== Jks tie tr-mSporter's mpnmtadve,I cerdfy Chat the contms-&>So*od <br /> 4144 Z Therese Avenue Fy�mo,CA 9 V7 I 114r4li are pmkilg4d for Ehipmp.at jE aolatdaz,Ce xvi6 211 4plicable <br /> tsg�tl�css s_ <br /> ................. <br /> .............. ...... .......... <br /> ...... ..... <br /> .... ....... ...... ...... ....... ......... Rritc--- ----Amu-unt,- <br /> ............... <br /> ....................I............................. ........... <br /> �rp)Till S 2 AdOWTHL 11 MEDICAL WAST.9 SERVICE FF <br /> .. .. ........ .I...... ........................I I,.-,,-,.............-- <br /> SEP <br /> ................... I... .......... ...... <br /> ............... ......... . ........ .................................... ........... <br /> U1 9 <br /> .............. ...... <br /> RED BAG .......... <br /> 1PRI-ym- lmltn :. .......... ........ ....... <br /> . ....... ..... <br /> .......... .................. <br /> TUB I 39g <br /> ... .................. <br /> RegulaWd Njeffical Waste 6.2, UN3291, PG 11 <br /> Nf9DANND SIGNATURE: DATZ: <br /> 601/62 'd �S� [ "N AdN : 61N '0 [ 'add <br />