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To: Page 10 of 45 2016-09-12 13:06:14 CDT 18776791797 From:Customer Care <br /> AOL <br /> -W-61CALWASTETRACKING FORM NUMBER <br /> STA11ftffl6bM13rSTD <br /> StericydW RffFy CONIWr CHEMTRRO 1-8004Z4-9300 <br /> cuSlrofolEA NO.21= <br /> t <br /> I.Generator's Name Address and Telephone Number <br /> X'fTN:Dave Kdwalczyk <br /> QUEST DIMNOSUCS <br /> 229*1 19 MARCO LU BLDG 7 <br /> SMMMN, CA 95207- 6652 (209) 981-5931 6/27/2016 <br /> Cusromen Numean 6019888-002 GENERAYOR'S RAEGISTWON <br /> 2A.DESCRIPTION OF WASTE 28, CONTAIKERTYPE 2C. NO.OF 2D. VOLUME <br /> Regulated Medial Waste,n.o s., T1805 - 40 Gal Tub (Bio) (5.3 cu ft) CONTAINERSN"elll Cu Fl. <br /> 0 1 TUD till*jo'(T-9 011 'Et) <br /> 6 e9111 1111101112111114 Madbi Wasik A."" %44 <br /> A Cu Ft <br /> UNS291 RegulatedMC41cal Waste,n.os. - TMUTO; (4-V CU "I <br /> 6.2,PH C., ,_: 436-1 Tiab Ft. <br /> ReQUIffled MedlCal Waste,R.G.S., �--ITFAA (path)4�5 -(Ghosaa!20 <br /> Cu <br /> NUMP"I'll Ft. <br /> CC T U411 TEM(V.3:1UU 'T) <br /> w ftilulated hwfwl Waste,&O.S., Wnjj.-jB1Q)-/6W3! cya r/wcn=�c i%)73 <br /> Z 6.2,PG'l I Cu Ft. <br /> III UR32-1 9wa-(Rio)jewn-(Fhft)/CK43-(Cawmay-sal Tub(5.T51Jft-T <br /> R"11181all AlMaJiCal Waste,LO.S., CO Ft <br /> U10291 Regulated Medical Waste,n,os,, mw— - Diosysteas Gard So-a-rd-110-k- Cu 1115) <br /> 5?,P611 Cu Ft <br /> U <br /> 6 Regulated Medial Waste,Lox, Cu Fit. <br /> 600111)Regulated Medici!Waste,Ao.s.,j Cu Ft, <br /> a.Gartarator's Certification:-1 hereby declare that the contents of this consignment are fully,rid a TOTALS od7s Cu FL <br /> tlesorlbod above a proper sbipgrig name,and am classified,packaged,marked end label a ta V <br /> �Jia <br /> 41,Mrespect IlApaar concillicin Ifir Iran according to applicable International arid on ental regulate <br /> 00) if i -F 11 <br /> 4-TRANV0RTER1ArRff&Cy0je, Inc. This :Ls a Through Shilpment MUM N.. <br /> 4135 V. Swift Ave AppI1VU1f1M1%�W :3400 <br /> er <br /> Frooncio,O)k 93722 <br /> TRANSPOERTIFIC Recielpt of medical waste as gnatudemo Date <br /> Pr�Vryps Nettie SIrma:9� <br /> S.INTERMEDIATE HANDL 2/TRANSPORTER 2 ADDRESS: 9, <br /> Applicable Parmot Numbers <br /> INTERMEDIATE HANDLER/TRANSPORTER CERTIFICATION:Receipt of medical waste as described above. <br /> PrinUTAn Nam signatura Date <br /> IL JNTERM53tXrE HANDLER 3 MANSPORTER 3 ADDRESS, Phone 0: <br /> Applicable Permit Numbers, <br /> INTERMEDIATE HANDLER/TRANSPORTER CERTIMATION.Receipt of medical waste as described above <br /> PtWWTypo Name Signage Date <br /> 7.DISCREPANCY INDICATION <br /> 8A.DwIgnated Facility. am Ilty; 8C,Alternate FaCMW. 8b Attemat®t*ac8lty. <br /> e eicy <br /> rcle,Inc, ft <br /> Inc. recycle,Inc. <br /> 90 N.FOXWO OdO 1561 Shelton On" <br /> Fresno;FNorth t Lake,UT 84054 Hollister,CA 95023 <br /> Ll StetNAM <br /> (868)783-7422 (86M783-7422 (SW)703.7422 <br /> Ta �7 2016 <br /> 1rhoe BA-448-JA-06 TWOST 03 <br /> lff <br /> CC TREATMENT 466�ftrfy that I have been authorized by the applicable slate agency to accept untreated medical waster.and that I have <br /> received the above Ind' led Wastes In accordance with the requirement outlined in that authorization. <br /> Print/type Name Signature Date <br /> Niiilgiia Fu It 13 <br /> O <br /> ORIGINAL <br />