Laserfiche WebLink
To: Page 5 of 45 2016-09-12 13:06:14 CDT 18776791797 From:Customer Care <br /> [CAL WASTE TRACKING FORM NUMBER <br /> Steric Cie` STANDARD MANIFEST Glili-AIMIS-SM <br /> erWX <br /> FffiCtOODYIPT.CHEMTREC I-8011-444-WOD MDFR00147N <br /> ft4pk kogkm 1W CUSTOMER NO.21132 <br /> all <br /> 1.Generator's Name,Address and Telephone Number �� � F (� { f <br /> ATTU:Dave Kowalczyk <br /> QUEST tj1AGVOST3:CS <br /> 2291 N MARCS LW BLDG r <br /> STOCrMll, CA 95207- 602 (209) 951-5831 8/1/2016 <br /> CuswmER NumsEn 6019888-002 G131111=11-13 REGOSTRAU011 <br /> 2A,DESCRIPTION OF WASTE 28. CONTAINER TYPE 2C.NO.OF <br /> 2D. VOLUME <br /> 1=01 Regulated Medical Waste,nA s. TBOS - 40 ftl Tub (Bio) (5.3 (Yu ft) CONTAINERS 1 <br /> 6,2.P611 Cu Ft <br /> ON3291 Reatflated Medical Waste,mos, T849 - 37 Gal Tub (11110) (4.9 CU %t) <br /> 0.2.Nil N Cu R <br /> X UN3291.Regulated!Medical Waste,no.j, 4 ad Gal Tub 03.01) (5.so ou tt) <br /> 8.2.Poll Cu Ft.— .1 q <br /> UN3291 RecOlated Me tical Waste,n.o.s, xa'&J.-%=W)fTFt5_(Iiiartil)j <br /> 6.2,PQli Cu Ft, <br /> W U0291 Regulated Moffical WjS_jeU.&, WB31-(Bio)7031-(Path)JWC31-(Chem*3 31 Gi <br /> l TUT('4-,14GUf7J_ <br /> _6.2.Nil Cu Ft. <br /> a UN=1 Re"ted Medical wiste._R.O-S� W843-(Bio)/Etf42-(Path)/CN42-(Chemoj Tub I S.7 CUPT) <br /> 6.2,PG11 Cu Ft <br /> UN3291,ReWjl*d Medical Waste,11AS., XRB - Biosystems Cardboard Box (4.2 cu -ft) <br /> 6.2.PGII GU Ft. <br /> 6.7UNMPGIII Ruled Medical Waste,n.o,s, <br /> , CUFL <br /> UN32DI,Remlitated Medical Waste,no,s, <br /> 62.PGII Cu Ft <br /> &Generator's Certification.,"I hereby declare That the contents.of this consignment are fully and a sly TOTALS)0- Cu Ft <br /> described above by the proper shipping name,and are classified,=8981d acar -and <br /> ,is �,marked and label <br /> are I ata respects In prp��!don for transport according*op emational and gov ental regulations.' <br /> STS1.2"Zoll <br /> A <br /> are <br /> Name A )I <br /> jlPORTER I-A It -0 <br /> TEfficycle, Inc. [:3 This is a Through BtliPMent — <br /> mit Pre <br /> 4135 W. swift Ave ApplbV%U er gw 3400 <br /> rcesno,cA 93722 <br /> rc TRANSPORTER 0, CATION:Receipt of medical wasts describe <br /> 010 Z t" 9W4 <br /> PrInMpe Name Z'95"_10 R� 'h' Data <br /> S.INTERMEDIATE AANDLER 2 ITRANSPORTER 2 ADDRESS: -=70' phone <br /> Applicable Permit Numbers <br /> INTERMEDIATE HANDLER!TRANSPORTER CERTIFICATION:Reempt of medical waste as described above <br /> PdrWTWm Name Signature -Dale <br /> a.INTERMEDIATE HANDLER s(TRANSPORTER 3 ADDRESS: Phone#: <br /> Applicable Permit Numbem- <br /> R11 INTERMEDIATE HANDLER/TRANSIPORTM CERTIFICATION:Recar ptofmadical waste as described strove <br /> J! PrIntfrype Nome Signature Dale <br /> F.DfscfVePAN0Y OND CATION <br /> yr <br /> SA,Partillpieted Facility. 10 8%Alternate Facifitir; [39C.Alb.-mataft Oil $0.ARM&%FACIlityl <br /> .9tairicycle,Inc. Sb&-Yde,Inc. ;a;=,AC. <br /> 4435WORTIZ 90 N.Foxboro owe 1551 Shelton CloveowaMOAINE North Sol LaIm.LIT 84CS4 Hollister.CA 95023 <br /> (868)783-7422 (866)783.7422 (868)783-7422 <br /> T910arnis 0 12016 3A-448-JA-36 TWOST83 <br /> TREATMENT FACILITY.,I Cart that'l have been authorized by the applicable state agency to accept untreated Medical wastes and that I have <br /> received the above Indicated wastes in accordance With the requirement outlined In that authorization. <br /> PrinV7yps Noma Signator Data 4 <br /> ORIGINAL <br />