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0 <br /> SharpsTRACER Manifest: 3705841 Weight(Ibs): 13.15 <br /> I certify that the contents of this container <br /> have been received,treated,and disposed <br /> of in accordance with all local,state,and federal regulations. <br /> Date Received:4/20/2012 <br /> /s/Meghan Weisel <br /> The medical waste was treated in accordance with 25 TAC§1.136 <br /> Permit 1741A <br /> Treated on 4/20/2012 3:23:00 PM-AC <br /> Batch 1-2012-0420 Pallet 4-Cycle 2562 <br /> Meghan Wclsel <br /> W�w1t�G�,Q <br /> 37058,11A <br /> Rrb <br /> • SH . <br /> Compliance,Inc. 3705841 <br /> TakeAway"" Recovery System Tracking Document <br /> Complete sections I through 6 on this triplicite form,Keep*Shipper*(bottom)copy <br /> of completed form for your records,Place remaining copies in the plastic pouch on <br /> the outside of the box.Read and follow the packaging Instructions included in the <br /> shipping box. <br /> I.Shipper's printed name,complete address&telephone, <br /> Quan Vo Anh Nguyen DDS <br /> 702 Porter Ave.,Ste F <br /> Stockton,CA 95207 <br /> zop Del Er — 01 (0 it B <br /> Product-85000 <br /> 2. Description of contents: <br /> 3. Signature of person completing this form: <br /> 4. Date of shipment— a?' )412012- <br /> 5. Weight of packaged box. I k s <br /> Comments or additional Information added by Shipper: <br /> TO BE COMPLETED BY SHARPS COMPLIANCE TRSA 71MENDPROCESSING FACILITY <br /> Printed certification of receipt and procening;'I certify diat ft conterift of this cardaft*rhave <br /> been MWNW scowdance Win lboal slate.and f9deralregulaffons" <br /> TrooltmentfProcessing Facility Treatment/Processing Facility Representative <br /> Sharpe Environmental Printed Name- <br /> Services <br /> 1544 NE Loop Signature' <br /> Carthage,Texas 76633 Date Received: <br /> Date Processed: <br /> Treatment kikii6d: <br /> Weight: <br /> If section above Is blank,please referenceTDH 1741 TACB R-9620 elechvnic,signature at the top of this docUrneft <br /> IN CASE OF EMERGENCY OR DISCOVERY OF DAMAGE OR LEAKAGE, <br /> CALL 1.000.T72.6667 <br /> Part#100472 Rev C <br /> White-Fite i Pink-File I Yek;w.ShIpper <br />