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To: Page 9 of 45 2016-09-12 13:06:14 CDT 18776791797 From:Customer Care <br /> - 11111111 ECI&LWASTETRACKINra FARM mjmBER <br /> 0* � Stericyde* IWN Wok&01:%RW.F0NTf8P CHEMTREC I-soo-424-9 bill STANDARD MANIFEST 001-10-06-STD <br /> 0--690 FMW6"ft"r%V._&dVfiW au <br /> 49 . CUSTOMERNIM211S2 MDFR0010K.T <br /> 1,Generator's Name,Address and Telephone Number <br /> ATTK-.Dwe Kowalc zyk <br /> OUBST DIAGNOSTICS <br /> 2291 111 MARM LN BLDG I <br /> (209) 951-5821 <br /> CUSTOMER Ntmsert 6019888-002 GENeRwoa,s REGisrstAnciN# <br /> 2A.OPESCRIPTION OF WASTE 213. CONTAINER TYPE 2C.NO,OF 2D. VOLUME <br /> U1113291,Regullided thedical Waste,ii.os., TE05 - 40 Gal Tub (Bio) (5-3 au ft) CONTAINERS <br /> 6.2.PQu Cu Ft. <br /> ON&Reaulated Medical Wage, TB49 - 37 Gail TUb (Rio) (4.9 CU tt) <br /> I Cu Ft <br /> CC UN3SI Regulated Medical Waste,mo a., TB14 - 44 Gal TUb(Bio) (S.9 -c-u—M <br /> 6.2.P&II Cr 127 Cu FL <br /> Ut= I Waste,mos, <br /> 62,lit,"ded Medica Cu Fl. <br /> KB31-(Bio)7UP31-(Path)1KC31-(Chemo)31 Gal TUST4.11077T <br /> Aegutated Medlml Waste,tws., Cu Ft <br /> W9111 Regulated Medical Waste,cos., NB43-(Eio)/pW43-(path)/Cw43-Cchemo) Gal Tuts PQ Cu Ft <br /> 6.4U'PQII Regulated Medical Waste.ri.o.s. xRB - Biosystems cardboard Bose (4.2 cu ft) <br /> CUR <br /> UNM Reguteled Mafti Waste,mos, <br /> 6.2,P4 Cu Ft. <br /> 62,PBfi Regulated Meftl Waste,rLOS.. <br /> 3. 09 Certification:"I hereby cleclaria,that the contents of this consignment are lully and accurately TOTALS► _Cu Ft. <br /> ad by the proper shipping name,and are classidied,packaged,maeked and labellarilplace, ,and <br /> (�2 .0 4 'a f"' � <br /> ti. <br /> I all pecks In proper condition for transport according to applicable international and nab mrmntal reg�tdal - <br /> XX 't - - 7 <br /> 'P, MM <br /> -P VW Name <br /> SPORTER'A"N'Rhoycle, Inc. This isaThrok'ghdItIpment Pbonelf. <br /> 4135 W. Swift Ave Al"It"94prel""ej 3400 <br /> Franno,CA 93722 <br /> 06 <br /> TRANSPORTS P :cal waste as described a <br /> ,ARRTIF'j'A7 Racelp of <br /> Prinl1type Name 7­74739 Date <br /> S.INItAMEE)IATEFMOLER 21TRANSPORTER 2ADDRESS. Phone <br /> Applicable,Permit Numbers: <br /> rA INTERMEDIATE HANDLER ITRANSPORTER CERTIFICATION:Receipt Of medial Waste as descnbed above <br /> Print/type Nam Signature Dale <br /> a.jNTERPEDiATE HANDLER 3/TRANSPORTER 3 ADDRESS: Phone#: <br /> AppWable Permit Numberw <br /> gal <br /> INTERMEDIATE HANDLER/TRANSPORTER CERTIFICATION:Recept of medical waste as described above, <br /> PrInYtypis Nam Signature —Date <br /> 7.DISCREPANCY INDICATION <br /> I ted FaGlty st3,Alternate Facility: sc. RIO KEY: BID Aftemeft Fac Nip. <br /> startcycle,ho. SWdWde,Inc. SterIcycle,Inc. <br /> 4185 W mom 80 N.Foxtoro Drava 1561 Shsbn DM <br /> Fres,no,693A 10M North 9Lelia,UT 041354 Holgater,CA 95023 <br /> (066)783-7422 (886)783-7422 (866)783-7422 <br /> 3A,448-JA-38 TSMT 83 <br /> T910ST23UL 05 2016 ' <br /> I I <br /> Pit TREATMENT FACILIT91r hat I have been authorized by the applicableale agency to accept untreated medical wastes and that I have <br /> rOCSIVed the above indicated�fttes in accordance with the requirementoutlined <br /> in the h"jz' <br /> Prinvrype Nam* Signature Date <br /> twt <br /> ORIGINAL <br />