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07/14/2005 07:58 55983dr7Q52 <br />61NOM160 <br />Medical <br />c1iimposel <br />Tri g Document <br />PAGE 03/25 <br />SERVICE ADDRESS <br />DRIVER: N5 <br />5165 DEUEL VOCATIONAL INSTITUTION <br />ORDER# 12868 <br />Type PR] Del <br />SITE PHONE: 209-330-3882 <br />23500 KASSON ROAD <br />POODV103015 <br />TRACY. CA 95376 <br />CONTACT' DON WILCOX <br />20B <br />DATE: 01/13/2005 Thursday <br />ME <br />OT'AL WEIGHT <br />Container Quand <br />Container Quantity <br />Container Quantity <br />DE P/Ul Del <br />Type PR] Del <br />Tape PIU Del <br />48B <br />32B <br />Transporter <br />44B <br />20B <br />S-14 <br />0BCA <br />Shar s <br />S-22 <br />13816 <br />Sharps <br />S-32 I <br />AL WEIGHT <br />Container Quantity <br />Container Quantity <br />Container Quantity <br />TZ PIU Det <br />Type P/U Del <br />Tye P/() Del <br />44PA. <br />8CH <br />CCPA <br />20CH <br />8PH <br />CCPH <br />20PA <br />2.SCH <br />5-14PH <br />16CH <br />2.5P <br />S-22PH <br />16PH <br />CCCH <br />S32 -PH <br />Customer Certificltiszn: This is to eertil}' that the above name ted medksi waste is properly classified, described, packaged, marked and labeled, and <br />in proper condition f cion accordingto the upptica u sof the DOT. <br />Print Name Customer Sign aha re Date <br />alifornia Medical Disposal, Inc <br />I T ese Ay <br />F 93725 <br />S 50 <br />s it 61 <br />saa2 � ( ' <br />Authorized Signature Date <br />VCalifortala Medical Disposal, Inc. <br />4100 E Therese Ave. <br />Fresno, CA 93725 <br />(559)-631-5850 <br />Reg. Haulers # 446 <br />P TATS/ <br />uthoriaed 5 cureDate <br />CalifOrnia J Iedical Dis)osal, Inc. <br />4100 E Therese Ave. <br />Fresno, CA 9372- <br />(559)..8345850 <br />Reg. Haulers # 4461 <br />PERMIT # TS/OST32 <br />X <br />Authorized Signature <br />X <br />Authorized Signature Date <br />Authorized Signature Date <br />e <br />C. <br />Cafifornin itedical Disposal, Inc. <br />4100 E Therese Ave. <br />Fresno, CA 93725 <br />(559)-834.5850 <br />Reg. haulers # 4461 <br />PERMIT A TS/OST32 <br />x <br />Authorized Signature Date Ree'd <br />x <br />Date Authorized Signature Date Recd <br />UN3291, PG , 6.2 <br />