Laserfiche WebLink
®• Stericycle* SE OF,ENt N CT: C EC 11-1300-2 1 <br />IDS -.0 : i <br />gygypQgl Opt t STo <br />MUL' ItUU /9 <br />nn.nq.Md�srua Ka� <br />a <br />'. Generator's Name Number <br />OH; <br />Caria Vallaetn/P ojecl= <br />BIO/ST ,ICES IMMD CAMOCCHUR <br />1801 E. MARCH LANE BLDG 470D/480D <br />STOCRTON, CA 95210 <br />(209) 467-6395 <br />11/19/2008 <br />6062804-003 <br />CUSTOMER NUMBER GENERATOR'S REGISTRATION# <br />2A. DESCRIPTION OF WASTE <br />2B. CONTAINER TYPE <br />2C. NO. OF <br />20. VOLUME <br />REGULATED MEDICf L%n.o.s..6.2, <br />8502/RSQ2 — 2 Gal Sharps Rousable (0.3 cu ft) <br />CONTAINERS <br />UN 3291, PG It <br />Cu Ft. <br />REGULATED MEDIC gen.os..6.2, <br />B3031R903 — 3 Gal ffliarpaReusable cu <br />UN 3291, PG II <br />Cu Ft. <br />CC <br />REGULATED MEDICO&S&n.o.s.,6.2, <br />asulsIR130ts - [ ' <br />O <br />UN 3291, PG 11 <br />Cu Ft. <br />Q <br />REGULATED MEDIC n.os.,6.2, <br />M <br />UN 3291, PG it <br />Cu Ft. <br />W <br />REGULATED MEDICAL WASTE, n.o.s.,6.2, <br />TBUZ -JLDQ a 01 <br />W <br />UN 3291, PG ti <br />Cu Ft <br />REGULATED MEDICAL WASTE, n.o.s.,6.2, <br />UN 3291, PG 11 <br />Cu Ft. <br />REGULATED MEDICAL WASTE, n.o.s.,6.2, <br />UN 3291, PG it <br />O .C.LL <br />KY,131 - PhycTv*,o-c4.c( rc,,t 4;3 <br />`fff <br />`' 3 Cu Ft. <br />REGULATED MEDIC SW.t 2, <br />KRGS — 11beeled Rack (59-4 Cu ft) ' <br />UN 3291, PG 11 <br />Cu Ft. <br />Regulated Medical LCR - Rio systems cart oc Box ( Cu ft= <br />Cu Ft <br />3. Generator's Certification: "I hereby declare that the contents of this consignment are fully and accurately TOTALS 10' <br />' 3 Cu Ft <br />described above by the proper shipping name, and are classif led, packaged marked and labelled/placardad, and <br />are in all respects in proper condition for transport according to applicable international and national governmental regulations" <br />)/%I Printedfryped Name 1144-0 y1adoQ4M <br />W 4. TRANSPORTER93dKW61e, Inc <br /> <br /> <br />0a za TRANSPORTER CERTIFICATION: Receipt of medical waste desab above - <br />0 <br />I <br />Pdnt/Type Name ` V. Signature <br />shipment <br />S. INTERMEDIATE HANDLER 2 /TRANSPORTER 2 ADDRESS: <br />,°CLr INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Receipt of medical waste as described above. <br />Printf ype Name Signature <br />Phone 8: a.,..., <br />Applicable Permit Numbers: <br />Date <br />Phone C <br />Applicable Permit Numbers: <br />Date <br />W <br />11. INTERMEDIATE HANDLER 3/TRANSPORTER 3 ADDRESS: Phone #: <br />¢Qa Applicable Hermit Numbers- <br />WQ <br />INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Receipt of medical waste as described above. <br />a <br />PrintirType Name Signature Date <br />7. DISCREPANCY INDICATION a , a <br />SA. Oes�nated FaClliry: 88. Alternate Facitlry: ®8C. Alternate Facility: St). Alternate Facility: <br />sTERICYCLE INC I STERICYC1 E INC STERICYCLE INC STERICYCLE INC <br /> <br /> <br /> <br /> <br />srt /� S <br />oWC TREATMEN FACILITY: I certity that I haveeen uWjLa applicable state agency to accept untreated medical wastes and that I have <br />I- received the above indicated wastes in aWd `dance�+with the requirement outlined in that authorization. <br />PdnVType Name VV tune Date <br />00009. �� <br />