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9 <br /> SharpsTRACER Manifest: 3705863 Weight(Ibs): 13.85 <br /> Y 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: 5/1/2012 <br /> /s/Meghan Weisel <br /> The medical waste was treated in accordance with 25 TAC§1.136 <br /> Permit 1741A <br /> Treated on 5/1/2012 4:38:00 PM-AC <br /> Batch 1-2611a-Cycle 2611 <br /> Meghan Wcisel <br /> W t1t <br /> Compliance, <br /> RecoveryS' UNIONS <br /> y7 _ <br /> Complete sections 1 through 6 on this form.Keep`Shipper'(bottom)copy of <br /> completed form for your records,piece remaining copias In the plastic pouch on the outside <br /> of the box For detailed Instructions,infotmedon regansm contents,and training purposes, <br /> see Packs 9 and Shipping Instructions inclosed in this shipping box <br /> All Items below must be filled out completely. <br /> L2lnrelt AA °fiat <br /> S.SAlpptr Fatll&te N r ataNr#) 2.Description d <br /> 1�. lz Used <br /> S.SBttt rest t�ptr <br /> ollston, T 770-5,1 �,ofthlpp� <br /> CRY -1-71 r"-'432-3000"' <br /> Fho,y e.0aftafa . <br /> Comments or additional Informationes byShipper: 4.Wmight of pad aged bon <br /> TO BE COMPLETED 8Y SHARPS COMPUANCE TRF.4TmeNTlPROCESSING FACiLl ry <br /> Printed Certification of receipt and processing°t cer*Heat the Contents of this tonilli er <br /> have been receiver!,(sated and processed In accordance with lacad,slate,and federal <br /> regrdations.- <br /> Treatment/ProcessIng Facthity T ssing Facility Representative <br /> Sharps Environmental <br /> Services Printed Name: " <br /> 1544 NE Loop Signature: <br /> Carthage,Texas 75633 Date Received: <br /> Data Processed: <br /> Treatment Method: <br /> Weight: <br /> If section above is blank,please reference <br /> TDH 1741 TACE R-9620 electronic signatilm at the top of this document. <br /> IN CASE OF EMERGENCY OR DISCOVERY OF DAMAGE OR LEAKAGE, <br /> CALL 1. .772,5657 <br /> White•Flle!Pink+11e 1 Yellow-Shipper Part 8100472 Rev 0 <br />