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171/21/2005 06:48 559834" PACE 05/25 <br />Medical <br />T' cking Document <br />Name: �� �.- Date- <br />Address: _ _ Acct • <br />City: "C+�o.t to Driver: <br />State: � zip: Customer PO # <br />Phone: _ 7,01--3�- <br />1\C INEiZ.1TU)N, WASTE i FellEV"AWINN <br />Container Quantity <br />Container Ouaatity <br />Type P/t) Del <br />Type P/[1 Del <br />20CH <br />BCH <br />20PA <br />8PH <br />20PH <br />2SCH <br />16PH- <br />2SPH <br />16CH <br />umi"uauc a we .a w urtay tuat toe aoovegWOING r Usti waste 19 Property ctasssuetl, described, Packaged, nwkcd and labeled, <br />and In prapar n twn amrdtng M a r the DOT. <br />x f Z <br />F iet Name Customer Signature Date <br />Utornia Medical Duposal, Inc. <br />4100 IE Therese Ave. <br />From, CA 93725 <br />(559). <br />g. Ila 61 <br />Authorized Sigomtnce to <br />x X' <br />Authorized Signature Date Authorized Signature Date Reed <br />d2California Medical Disposal, Inc. ❑ <br />4100 E Therese Ave. <br />Fresno, CA 93725 <br />(559)-834-5850 <br />Reg. haulers # 4461 <br />PERMrAr tt TSIOST32 <br />Authorized Signature wate Autborizod Signature Date <br />Q California Medical Disposal, Inc. O ❑ <br />4100 R Therese Ave. <br />Fresno, CA 93725 <br />(559)-834.5850 <br />Reg. Hanlon @ 4461 <br />PERhfIT # TSIOST32 <br />X X <br />Authorized Signature Date Authorized Sigoature Date Recd <br />