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SERVICE ADDRESS <br />5165 DEUEL VOCATIONAL INSTITUTION <br />23500 KASSON ROAD <br />TRACY, CA 95376 <br />- ` Trng Document <br />DRIVER' NB <br />ORDERN 19448 <br />SITE PHONE:2W830-3882 <br />PON DVI03015 <br />DATE: 04/21/2005 Thursday <br />PAGE 17/25 <br />Container Quantity <br />Container Quantity <br />Container Quantity <br />Tyr P/U Del <br />T e -P/U Del <br />Type PJC' Del <br />44PA, <br />8CH <br />COPA <br />20CH <br />8PH <br />CCPR <br />20PA <br />2.5CH <br />S-14PH <br />1.6CH <br />2.5P <br />S-22PH <br />16PH <br />CCCH <br />S32 -PH <br />)tscotn4r t,eruticaRgn: I tub is to Certify that the above named regulated medical waste is pruperly classified, described, packaged, marked and labeled, and <br />in proper condition for mportatioQ according to the applicable regal io the <br />Xtint <br />Name Cus otter Signature <br />Date <br />MUM <br />`CaCaliforniA Medica) Disposal, Inc.. <br />California :Medical Disposal, Inc. <br />4100 E Therese Ave. <br />4100 E Therese .Ave. <br />Fresno, CA 93725 <br />Fresno, CA 93725 <br />(559)-834-5850 <br />(559)-834-5850 <br />Reg. auier 4461 <br />Reg. Haulers # 4461 <br />a /OST32 <br />X <br />PERMIT 0 TS/OST32 <br />x <br />orized Signature Date Authorized Signature Bate <br />Authorised Signature Date Reed <br />4100 E Therese Ave. <br />Fresno, CA 93725 <br />Haulers a 4461 / <br />1T # T J'1- <br />orized Slgnature Date 7 Authorized Signature Date <br />r California Medical Disposal, JA -t. <br />4100 E Therese Ave, <br />Fresno. CA 93925 <br />(559)-834-5850 <br />Reg. Haulers # 4461 <br />PERNUT # TS/OST32 <br />x x <br />Authorized Signature Date —� Authorized Signature Date Rec-d <br />FUN3291, PC 11, 6.2 <br />