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®e e NON-HAZARDOUS WASTE SHIPPIN�bOCUMENT <br /> e®� Ste r,cyc I e Phone:866.783.7422 <br /> Website:www.stericycle.com <br /> Protecting People. Reducing Risk: r <br /> Generator's Name,Address& Telephone Number <br /> Vo <br /> (�- <br /> ��� S- 061r) Stlse-� <br /> Customer# b0$ 51� - v ! �J g7if <br /> Number Type Enter Amount Here <br /> Non-RCRA Waste <br /> (photochemlcal/photoprocessing waste) DWI I Galion <br /> Universal Waste(containing Mercury& <br /> Aqueous Solution)(Dental Amalgam) DW12 Gallon <br /> Universal Waste From Dental X-Ray <br /> Unit{scrap Metal Lead Foil) DW03 LBS <br /> I <br /> GENERATOR <br /> Print Name: { 4- n G <br /> r <br /> Signature: <br /> Date: <br /> DRIVER oo�tt � <br /> Print Name: <br /> Signature: <br /> Date: <br /> RETAIN COPY FORTHREEYEARS <br /> ODI-D3-VN(REV 6117i <br />