Laserfiche WebLink
I <br /> DQC# <br /> 2255 B q <br /> 2255 Barr 01ham Drive Ste.A a G .k <br /> Escondido,CA 92029Fln] g <br /> Ph:800-805-6236 r�� (� <br /> Pax:760-745-8786 lul M 1. P Cf11567 a0 9770 j <br /> MEDICAL WASTE DOCUMENT <br /> Generator/Address: Contact/24 Hour Emergency Phone#: <br /> San Joaquin Delta Cull <br /> 5151 Pacific Axe 3 59 <br /> Stockton, CA 95207 <br /> Transporter 1: _ ` Transfer Station: (If Applicable) �, r <br /> ingenium Group-LLC ettium <br /> 2255 Barham Drive,Escondido,GA 92029cA <br /> ' .tom 95035 <br /> mue <br /> DTSC Hazardous Waste Transporter Registration#4857 5;8575ti TS-1 <br /> 800-805-6236 <br /> Designated Disposal/Transfer Facility: (check one) <br /> ❑ Medical Waste ( HealthWlse ❑ Other: ❑ Other: ❑ Other: <br /> Services 4800 E Lincoln Ave. <br /> 7321 Quimby ST Fowler,CA 93625 <br /> Paramount,CA 90723 855-248-9473 <br /> 888-610-1311 Permit#:TS89 <br /> Permit M TSIOST94 <br /> Shipping Information: (Treatment Code:1=lncineration,M=Microwave,A-Auto v4 {i <br /> Description Count Cont.Type Est.Wt A °al WL Treatment New Tracking ID <br /> (Transfer Facility) <br /> UN 3291,Regulated Medical Waste,6.2, <br /> PG If ERG#158 i7 <br /> file <br /> LN 3291,Regulated Medical Waste,6.2, <br /> PG it(Pathological Waste ERG#158 <br /> LIN 3291,Regulated Medical Waste,6.2, <br /> PG II Chemothera Waste ERG#156 <br /> Pharmac6uticai Waste <br /> �4`R10 11M 1111 11 E. <br /> This is to certify that the materials described above a".e properly classrfled,packaged, marked and labeled and are in <br /> proper condition for transportation in a coYeanc�,4Itrvrle applicable regulations of the United States Department of <br /> Transportation and the State of lifor` a. g <br /> Generator: 3, I <br /> Na , # Signet pats: <br /> In accordance with CV,,&SC f 8040-Tracking Records,generator t nsporting medical waste shall maintain its copy of the <br /> shipping and tracking documents for three years. <br /> Transporter <br /> Name:(Print) ._ XK09A Signature: Date:p <br /> Qn w <br /> Trot fer S atian (ift pplicable)� <br /> Narr(d: <br /> (Print)' Signature: Date: <br /> Trans brter 2: if Applicable) <br /> Name:(Priht) Signature: Date <br /> esi-nated Dis osa Transfer Facility <br /> Nam . Sig e: Date: j <br />