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d / / 14/ 21945 07ee: 58 55983 ""X52 <br />faIr 0sposal <br />SERVICE ADDRESS <br />5165 DEUEL VOCATIONAL INSTITUTION <br />23500 KASSON ROAD <br />TRACY, CA 95376 <br />xx 'ng Document <br />DRIVER: <br />NS <br />ORDER# <br />17063 <br />SITE PHONE:2094W-3882 <br />PON <br />DMO3015 <br />CONTACT. <br />DON WILCOX <br />DATE <br />03M7/2006 Thvsday <br />PAGE 12/25 <br />Container Quantity <br />Container Quantity <br />Container Quantity <br />Tv P/U Dei <br />T22e P/O Del <br />Ta a PIU Del <br />44PA <br />8CH <br />CCPR <br />20CH <br />8PH <br />CCPH <br />20PA <br />2.SCH <br />S-14PH <br />16CH <br />2.5PH <br />S-22PH <br />16P. 1 <br />CCCH <br />S32 -PH <br />U,J LUAU LUC auo.e names regusamoymewou waste is properly classwed, described, packa$3A Warked and labeled; and <br />In proper ccip4likn fo raospv" �u according to the applicable u t AOT. <br />3 - r4 -s <br />rint Name CUs r Signature . Date <br />' Kallforztla Medical Disposal, Inc. <br />(( 4100 Therese Ave. <br />Fres o '4725 <br />(55 5 SO <br />R a# 1 <br />T11 2 <br />So- a <br />Authorized S tore <br />Date <br />Inc. <br />-4100 E Therese Ave. <br />Fresno, CA 93725 <br />(559)-834-5850 <br />Reg. Haulers # 4461 <br />PER'vf1T * TS/OST32 <br />X <br />. u onzed Si tore Da <br />California :Medical Disposal, <br />4100 E Therese Ave. <br />Fresno, CA 93725 <br />(559)-834-5850 <br />Reg. Haulers # 4461 <br />PERMIT it TS/OM2 <br />Authorized Signature <br />X <br />Authorized Signature Date <br />X <br />Authorized Signature Date <br />M <br />Califorola Medical Disposal, Inc. <br />4100 E Therese Ave. <br />Fresno, CA 93725 <br />(559)-834-53W <br />Reg. H2tifers # 4461 <br />PERMIT # TS/OST32 <br />X <br />Authurizcd Signature Date Recd <br />Date Authorized Signature Date Ree'd <br />UN3291, P(;, 6.2 <br />