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Ulf 19/zut7 0f: 5ti 55983e '52 <br />z ' <br />i <br />Median! <br />LCsPmai <br />SERVICE ADDRESS <br />5165 DELIEL VOCATIONAL INSTITUTION <br />73500 KASSON ROAD <br />TRACY, CA 45376 <br />Tr"*ng Document <br />DRIVER: <br />NB <br />? ORDER# <br />17986 <br />SITE PHQNE:2M830.3882 <br />PON <br />DVIO3015 <br />CONTACT: <br />DON WILCOX <br />DATE: <br />03/31x2005 ThuT4aty <br />PAGE 14/25 <br />ComtAbler Quantity <br />Container Quantity <br />Container Quantity <br />T e Pill Del <br />T= P/t.° Del <br />Type P.ti Del <br />44P.A, <br />8CH <br />CCPA <br />20CH <br />SPH <br />CCPD <br />20PA <br />2.5CH <br />S-14PH <br />16CH <br />2.5PH <br />S-22PH <br />16PH <br />CCCH <br />S32 -PH <br />CUM2gr Certitleatloll: This is to certify that the above named regulated cuedical waste is properly classified, described, packaged, marked and labeled, and <br />in proper condition for transportation according to the applicable ti of the DOT. . <br />X tib �� IST at'L X <br />Print Name ustotner Signature hate <br />C4alifornia Medical Disposal, Inc. <br />100 E Therese Ave. <br />&Fmsno,93725 <br />50 <br />s # 61 <br />TSl T32.0 <br />U Mile' <br />orized Signature Date <br />Qalifornin Medlcal Disposal, Inc. <br />4100 E Therese Ave. <br />Fresno, CA 93725 <br />(559)-834-5850 <br />Maulers # 4461 <br />rl�7 <br />lOST32 5 <br />+1 tilor signature Date <br />C California Medical Disposal, Inc. <br />4100 E Therese A, e. <br />Fresno, CA 93725 <br />(559)-834-5850 <br />Reg. Haulers # 4461 <br />PERMIT # TS/OST32 <br />x <br />Authorized Signature <br />x <br />Authorized Signature <br />X <br />Authorized Signature <br />Date <br />Date <br />UN3291. PG 11, 6.2 <br />Date <br />California Medical Disposal, Inc. <br />4100 E Therese Ave. <br />Fresno, CA 93,725 <br />(559}834-5850 <br />Reg. haulers 9 4461 <br />PERMIT # TS/OST32 <br />X <br />Authorized Signature Dote Ree'd <br />.Authorized Signature Date Recd <br />