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u .its nbyRJ O 'S2 <br />t <br />NOW <br />00 Pace <br />Qf,Atl <br />i <br />SERVICE ADDRESS <br />5165 DEUEL VOCATIONAL INSTITUTION <br />23500 KASSON ROAD <br />TRACY, CA 95376 <br />4 <br />F <br />Tr , ng Document <br />DRIVER: <br />NS <br />ORDER# <br />19933 <br />SITE PHONE:209-830-3882 <br />PON <br />DVIOM15 <br />CONTACT: <br />DON WILCOX <br />DATE: <br />041284x005 <br />Thursday <br />PAGE 18/25 <br />!.�uLmer i -mon; i nu is to certtly inat the apove named regulated medical waste Is properly cia"Med. described, gackaged, marked and labeled, and <br />is proper condition i transmprt tiq_q a cording tc the appplicable re a ' ie of the T. <br />!s Print Name Customer Signature D D-- <br />+C <br />'alifornia Medical Disposal, Inc. <br />41110 E Therese Ave. <br />Fresno, CA 93725 <br />(559)-83-5850 <br />Reg. S ers #tST32 <br />P # T5 <br />AA <br />X thorized Signature Date +Q <br />California Medical Disposal, <br />Inc. <br />00 E Therese Ave. <br />Fresno, CA 937259> <br />(554-5as0 <br />Iteg. aulers 4461 <br />OST 2 <br />Authorized Signature <br />1. California Medical Disposal, Inc. <br />4100 E Therese Ave. <br />Fresno, CA 93725 <br />(559)-834-5850 <br />Reg. Haulers d 4461 <br />PERMIT # TS/OST32 <br />x <br />Authorized Signature <br />D e Authorized Signature <br />Date <br />Authorized Signature Date <br />L -N3291, PG 11, 6.2 <br />Date <br />California Medical Disposal, Iac. <br />4100 E Therese Ave. <br />Frrsuo. CA 93125 <br />(559)-834-5850 . <br />Reg. Haulers # 4461 <br />PERMIT # TS/OST32 <br />li Authoclzed Signature Date Rec'd <br />x <br />Authorized Signature Date Recd <br />