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611 / - / 11717'b 06: 48 5598345r <br />Medical <br />wisp©sal <br />SERVICE ADDRESS <br />DEUEL VOCATIONAL INSTITUTION <br />23500 KASSON ROAD <br />TRACY, CA 95376 <br />DRIVER: N8 <br />ORDER# 7537 <br />SITE PHONE: 209 -53G -30Z <br />PO# DVIO3015 <br />CONTACT: DON WILCOX <br />DATE: 09/3012004 Thursday <br />PAGE 09/25 <br />Container Quantity <br />P/Q Del <br />Container Quantity <br />T e P/U Del <br />Container Quantih <br />Ty c PA: Del <br />44PA <br />8CH <br />COPA <br />20CH <br />8PH <br />CCPH <br />20PA <br />2.SCH <br />S -14P <br />16CH <br />2.51'H <br />S-22PH <br />16PH <br />CCCH <br />S32 -PH <br />1-513 ro cerury met tae above named re lated medical waste is it <br />gu j1t V e assffted, described, packaged, marked and labeled, and <br />in proper condition for transportation according to the applicable rej1dation <br />Print Name Customer Signature Date <br />'"Walilbrnia Medical Disposal, Inc. <br />4100 E Therese Ave. <br />Fresno, CA 93725 <br />(559),8345850 <br />Reg. Iia ers 61 <br /># T3 <br />Authorized Signature Date <br />MAT, 1111 <br />'?'California Medical Disposal, Inc. <br />4100 E Therese Ave. <br />Fresno, CA 93725 <br />(559)•834-5850 <br />Reg. Haulers 9 4461 <br />PEis,;111,Z 0 47S/OST32 <br />Authorized Signature Date <br />Ql X <br />X Authorized Signature Date Autlwrized Signature Date <br />Callfornla Medical Disposal, Inc. <br />4100 E Therese Ave. <br />Fresno. CA 93725 <br />(559)-834-5850 <br />Reg. Kaulers # 4461 <br />PERMIT # TS/OST32 <br />X <br />Authorized Signature <br />X <br />Date <br />UN3291, PG 1I,6.2 <br />California Medical Di3pa5al, Inc. <br />4100 E Therese Ave. <br />Fresno, CA 93725 <br />(559).834-5850 <br />Reg. Hauler €! 4461 <br />FERMTT # TS/OST32 <br />X <br />Authorized Signature llate Recd <br />Authorized Signature <br />Date Reed <br />