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Medical <br />A. <br />Ti 4&ng Document <br />�•�.+d i11��f.:114 •+ <br />! Il 1 I16N V•f <br />PAGE 15/25 <br />C ontalner Quantity <br />T <br />Container <br />�vanu rrr.lvxaA <br />uandp' <br />Q Container Quantity <br />e P/ii Del <br />a44P <br />1P/CJ Del a P2i Del <br />8CH <br />CCP,A, ` <br />20C <br />20CH <br />8PH <br />CCPR <br />20PA <br />23CH <br />S-14PH <br />�6CH <br />2.5PH <br />S-22PH <br />16TH <br />rrru <br />ostomer Certification: This is to certify that the above named regulated medical waste Is properly classitted, described, packaged, marked and labeled, and <br />In proper condition for transportation according to the applicable regulations of the OT. <br />X (v1 St A0. 3- wlLl' iwtl.l X <br />Print Nanta Custotne ignature Date <br />atttornia Medical Disposal, Inc. — <br />4100 E Therese Ave. <br />Fresno, CA 93775 <br />(559)-834.5850 <br />Re . Ha s 61 <br />IrT TI ST3 <br />X <br />Autho ed Signature Date <br />= California Medical Disposal. Inc. <br />4100 E Therese Ave. <br />H resno, CA 93725 <br />(559)-8.34.5850 <br />Reg. Haulers # 4461 <br />X PER1r1IT # TS/OST32 <br />Authorized Signature Date Authorized Signature Date Rec'd <br />V `aittornia Medical Disposal, Inc. 1 <br />4100 E Tberesc Ave. <br />Fresno, CA 93725 <br />(559)-834-5gS0 <br />Reg. Hattlers # 4461 <br />PERMIT # T,5 ST32 <br />X �t/if( <br />X <br />utlrorized rWtlUe <br />Date <br />Authorl2ed Signature Date <br />California Medreal Disposal, ine. <br />4100 P Therese Ave. <br />Fresno, CA 93725 <br />(559)-834.5950 <br />Reg. haulers # 4461 <br />PEP–NUT # TS/OST32 — <br />X <br />Authorized Signature Date --� <br />U! -1291, PG 11. .2 I <br />N <br />Authorized Signature Date Recd <br />