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i i <br />Disposal <br />SERVICE ADDRESS <br />5165 DEUEL VOCATIONAL (INSTITUTION <br />23500 KASSON ROAD <br />TRACY. CA 95376 <br />Tra g Document <br />DRIVER-. <br />N@ <br />ORDER# <br />12868 <br />SITE PHONE: 209,830-3882 <br />T e P/LT Del <br />CCPR <br />t?V103015 <br />CONTACT: <br />DON Wli COX <br />TE: <br />01/13/2005 <br />Thursday <br />PAGE 23/25 <br />Container Quantity <br />Container Quaptity <br />Container Quantity <br />T e P/U Del <br />44PA <br />Type P/U Del <br />8CH <br />T e P/LT Del <br />CCPR <br />20CH <br />20PA <br />SPH <br />2.5CH <br />CCPH <br />S-14PH <br />16CH <br />2.5PH <br />S-22PH <br />16PH <br />CCCH <br />S32 -PH . <br />saa[o®er &.ernncat an_ I nus is to eertliy that the above name utated medical waste is properly clussified, described, packaged, Marked and labeled, and <br />In proper condjtion f e Cation according to the apj ica s of the DOT. <br />Print Name Customer Signature Date <br />Medical Disposal, Inc. <br />Wu� 61 <br />ST32 �s s <br />Authorized Signature Date <br />VC&fiforn12 Medical Disposal, Inc. <br />4100 E Therese Ave. <br />Fresno, CA 93725 <br />(559)-834-5850 <br />Reg. Haulers # 446 <br />k # TS <br />XK <br />uthorfxed $j jaA <br />re Date <br />California Medical Disposal, Inc. _ <br />4100 E Thenme Ave. _ <br />Fresno. CA 93725 _ <br />(559}.834-5850 <br />Reg. Haulers # 4461 <br />PERMIT # TSIOST32 <br />X <br />Authorized Signature <br />X <br />Authorized Signature Date <br />Authorized Signature Date <br />r <br />California Medical Disposal, Inc. <br />4100 E Therese Ave. <br />Fresnu, CA 93725 <br />(559434-5850 <br />Reg..Haulers # 4461 <br />PERMIT # TS/OST32 <br />Authorited Signature Date Reed <br />Date — Authorized Signature Date Recd <br />UN3291, PG II, 6.2 <br />