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06/05/2012 TUE 8:48 FAx 559 75 7469 St®aicycl® Freeno 10002/002 <br /> qw MEDICAL WAM TP=iaNQ F0 M NkXKA <br /> �® Sterkyeter 10 CASE OF 9WGENrY CUMACT.,CHEMMECa MANOMAOMANFMIM-10ee•97D <br /> '. }-•. +wrsro.: �puCe 10: 300 - 1 CUSMUM ROL 21132 �1DF 0 W <br /> 1,Gensciftf%Nanta,Addnwa and Telaphem N=bor <br /> AWN". Re,l Tavtngcura 1 NUNN 111111111111011� 1 Hill <br /> OEM SU1ii► DIALYSIS COMM <br /> 555 11 BEI$J MV BMT DR $TB 200 <br /> S'eOCEM, Ch 95.207- 3839 <br /> (209) 473-22,94 1$139 011 <br /> e+uals�stNtwwa 74 -Q4 naaapeaaamwlal® <br /> 2A.of ORIDt1ON OrWAMW 28. CONUOM tai M no.OF as VOLUMtt <br /> UN8291 Repultio9 A18d0y a as MWAINIF0 <br /> 0�t1 tB► - 9Q 0al ftb (vio a cu tt <br /> RBSrtttlil ti1SOC81 MSlU,o.or, <br /> 6� 1 TH49 - 37 Qal TO (1016$ (4.9 Ott ft) Cu Ft. <br /> �Ipa ,bra, 44 wL 1b*(K*) ts.9 c„ ttr)Pic UN <br /> a21, WLse,nou. TMI — 20 044 TO(Hio) (2.7'= tt) a <br /> &WPG11 flepwFUM e.nee_ "U — 20 ®al ?Wt I0it91) 42.7 oa Eel <br /> 62,Pail �e6 bas. rel5 - 20 alai sub (chemo) 42.7 cu !t) <br /> at poll <br /> � u efiO wage,DALCU K. <br /> era( 2-- l. I116 amn <br /> 3.Gwerslore O0r1111=1141a;9 timaby dedW rept the oatteatS of tela OWBIWPON weft**and eCotaelely YQTAL9 <br /> desalhed above by the pmpet aMppetr➢g nom.,end en CasallMd.pa ma end <br /> oarQ 4 and <br /> G�. �u FL <br /> era In all rp000aeo rim oroeer CotrQlAt►n Io(banapon a000rdlna to ate fW and nallanN awarnmentd *110nt' <br /> • X,;Pnm Name MI 1511. due OaM /114lr <br /> .d• A.TRANSPOWER I ADDROM Phone 9)27.5-1121 <br /> 5taricyvle. Inc.. This in a Thcemh Ship•aecat Applipble POM*MMMW, <br /> 4135 G;wt Swift Aaas_ <br /> 1c, Fcea7tu,ca 93722 tiOuleC Reg!► 3400 <br /> d THANBPfORTCR CERTIRCATWHi Rewimof moam aim dese*so am <br /> r P .dame R�I7 V, , tvr® onto d 14 11 <br /> I a L INTERMEDIATE NANDWR AITRANSPORTIR 2ADDRISM: Phoria c <br /> Applimbb Pia W400m, <br /> WMIRMEWAiE HANDLER/TRANSPORTER CEATIFICA !pt of medw wide eA dem bad above, <br /> Pft%pe Nems We <br /> a INTERMEWJifE HANDLItR 9l7AAA19P 3 ADORE89; prom r. <br /> A Penne t�n�M <br /> INTERMEDIATE HANDLER ITRANSPOW91%CE A Ipt m meant weete a&saw aww. <br /> Prtra/Ws Mama Bt Mum Data <br /> 7AISCREP ICY OIDICOUN <br /> • *j a to, Nadh w L&M,UT <br /> rAr fftwir, OIN AfYade F*Wlilq: U Sc,ADWrAta Faditp o•otara <br /> �e IttG•Atti>ktaae Il1p tIfIC , rtC <br /> 4139'W.SWPTAVe 90 N 1100 1346 DOW so c 2775 WMWT <br /> FREDNO.CA L Nt?ltlTbl%ALT UUM CM,UT 91tn LAWOu.CA 9SS77YMON.CA w= <br /> t666�276-11711 `9Qlyaas-1656 tela} -2)77 i��a:�o <br /> Tafrzsrn NOV 14 <br /> QUE WILSON <br /> TREATMENT FACILITY.1C�et( 1 have bsert authorized by the a Dross eDenCy to accept untreated me41oa1 wacws end that I h" <br /> received tho above Inc![W l' In aecorda1=withthe mquf► audined In Inet auth4dZXt1 <br /> Nemo _ ITT, c;11 Ya1191m, <br /> OFACIINAL <br /> Received Time Jun, 5, 2012 9: 04AM No. 0067 <br />