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11/12/2010 14:19 2092391W BUSINESS OFFI PAGE 24
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<br /> IN CATS OF EMITMENCY CONTACT:CHRMrREC 1.60G.42"30 ANongo mAmFEsr 09-1ano sm
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<br /> 1.Generstor's Name,Address and Telephone Number -
<br /> A`TTN: Cathy/Maxine
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<br /> 410 EASTROoD AvE 11 1
<br /> MA , •CA 95336-- 3161
<br /> 1 WITOMER Wasma ,� ,
<br /> 2A.OFBCRIPTION 0FwAS7E z CONTAINER TYPE 2C.No.OF 20, VOLUME
<br /> 8?•2ii Reptdated UNical waste.n,o.s., CtnaTAttN[RS
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<br /> UN3291,RepttLetntl Medical V%qw,n e s-
<br /> 62,P611 _
<br /> a; UN3291,�itatcd I,tecal waste.n.o.s., u A'
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<br /> 4 UN3291,ReVvle"d Aedkatt ftft'
<br /> 6.2.P611 T821 - 20 pal %%ab(eio) (2.7 cu ft) Cu IL
<br /> W UN3z91,Re"ated Medical ft"10.n,o,r,
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<br /> UN3291 Reptdaled Mnittrad wrtsle.4o.s.. _cu t
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<br /> UN3291,Repubtlail Meftw Wavc,aos.,
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<br /> UH3291 ReptrMted Medle d Wtaia,n,n,p„ u R.
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<br /> 2.Generator's cenillesttore_-1 hereby :War®that the wmenls of Das consignment®re fwy and xcmreltety 7oTA LS 0-
<br /> I described above by�hq prol:w c.M;tr"name,and Arg CaaaAiriad,packngnrl,marked And Isttmlind/pi mrarrtad,and
<br /> Are In all raapncca in nrnpar MnAalon for tranwon accordino to nordleable international and nab"al cove meal reowaliom"
<br /> 1 a IPrintedllryped Name pinto
<br /> M 4,TRANSPORTER 1 ADDRESS: PBton®e:
<br /> Stpriclrcler Inc. f apWicnhlct' Dior � — t)
<br /> Q® 47135 Meat. Swift
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<br /> Th 1.6 13 Thtou 3hi.p'1Aen-L
<br /> EL TRANSPOWER EENMROW.Hpi of rnmim W*3to as dea abmm.
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<br /> s.INTFRMFDIATE HANMER 2/THANSPOATER P.Af70RESS: Phcmo f:
<br /> ApvlkmbtA ParmO Numbera:
<br /> PIVFERAAEt]IATE IM,AI+tgI.t=R/1rRAINSPOt;tTlER ClEFR1FIi:ATI(W'la€w:wM N nnd:wnl w"rta ere!meeorlb®^.P.txtu!^.
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<br /> F6ampa Nanic SiAnaturC_ __ 'Joao
<br /> yr 6,INTERAEDIAT6 HANDLER 3 r TRANSPORTER 3 ADDRESS: Phnru®a:
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<br /> I ¢ Applicable Permit Number:
<br /> a c INTERMEDIATE 4AND1L.ER pTRANSPORTER CER71RCATM! M mne!Icrl w+-+c as ri!�cnneA aE>�^
<br /> 13t4ntrtyo2 Name Sianeture Oata
<br /> . . 7.DISCREPANCY INDICATION p/�,�EWILSON
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<br /> @A,D".—I meK'd F®t111N: r twined E.eettN: �An.Aftmwte c.eNhy
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<br /> v Sbartllyda Inc-Autoclava a Ino-IndneralJon ( Stulcyclo
<br /> „,,tI1tn�tc-Autoclave 5mrkvde Inc-Autodave
<br /> 41361Af.SVM FT AVE 317 100 VVES 1345 r•+,yoomne Dflve Ste C 2775 E 29TH STREET
<br /> FrGNo,C.A 93722 CITY,UT San Lgar+dro,CA,9437E
<br /> VERNON,CA a0023
<br /> � (5$99 ZT5-Qg9Q it 1� -'9 a55 tj3 t Q)56?-�7Et (3231362.3ed�t
<br /> "$31,T$fp T25 TSd0 2 Class V!ndnemllon F .MIW S1 t72 P-E.P-t t5
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<br /> ua TREATMENT FACILKY:1 certify that I have been authorized by the oppli able state agency to accopt untreated mcdcat wastes and that I ha”
<br /> P received 1ha above indiCalpid wastes in 8=rdanee with the repturement outlined in that authorization.
<br /> Print?ypa Nemr. _:rQnilurn Dale
<br /> ORIGINAL
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