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ROUTE <br /> 060 <br /> Stericycle Regul.A. d Waste. Shipping DAment <br /> DOCUMENT NO.:—... I � 111111!1111 i1milil 1111 iii�iii 11!111 �,�i�=_��� <br /> BIOTRACK- <br /> Medical Waste Tracking System ACCOUNTNO.: <br /> I Nq g:j <br /> DRIVER'S ID: <br /> Name ARRIVAL TIME <br /> Address DEPARTURE TIME <br /> City - State State Z_ <br /> Emergency Contact 800-234-0051 <br /> Phone <br /> OEM L ' <br /> AUTOCLAVABLE WASTEINCINERATION WASTE <br /> % Cont Quantity <br /> Cont Quantity Cont Quantity Type P/U Del <br /> Type P/U Del Type P/1J Del TP14 <br /> TB57 SH05 ITB1 5 <br /> TB49 SH06 TY1 5 <br /> TB35 --SH07 ,,I SH12 <br /> T.B24 SH08 SH14 <br /> TB21 SH09 SH22 <br /> TB14 SH1 1 F014 <br /> T1306 SH59 BC99 <br /> ST75 SH60 BP99 <br /> 732 SH91 SH24 <br /> ,jH03 BX99 SG22 <br /> SH04 SH99 SG50 <br /> GENERATOR CERTIFICATION: This is to certify that the above named materials are properly classified, described, packaged, marked and labeled, and are in proper condition for <br /> transportation according to the applicable regulations of the Department of Transportation. <br /> x X <br /> Print Name Gener6tor's-Signature Date <br /> FG57 RX02 RX33 <br /> XM99 RX03 RX99 <br /> TD86 RX10 <br /> RX27 <br /> Stericycle, Inc. E] Stericycle, Inc. E] Stericycle, Inc. <br /> 28161 N.Keith Dr. 28161_N.Keith Dr- 11875 Whiterock Road <br /> Lake Forest, IL 60045 Lake Forest, IL 60045 Rancho Cordova,CA 95742 <br /> (323) (323) 362-3000 (916)985-5506 <br /> Haz. Haz.Hauler, Reg.#3400 MWTS Permit#34-6-P <br /> X x x <br /> Authorized Signature Date Authorized Signature Date Initial Date Received <br /> ........... <br /> L encycle, Inc. Stericycle, Inc, Stericycle, Inc. <br /> 4135 W.Swift Avenue 1345 Doolittle Drive,Suite C 90 North 1100 West <br /> Fresno, CA 93722 San Leandro, CA 94577 North Salt Lake, LIT 8405L <br /> (559)275-0992 (510)636-9502 (801)936-1555 <br /> MWTF Permit#10-43-P MWTS Permit#19-23-P x Class V Incineration <br /> Treatment bv autcclavina I\jltAJTF Permit#37-48-P, Permit#91-02 <br /> 7 <br /> - "' 1, <br /> 1#`37 2„ 1 a2 <br /> "- Author ed Signature Date Treatment by incineration <br /> GENERATCNPI COPY. <br />