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11!12/2010 14:19 209239 BUSINESS OFFI PAGE 28
<br /> ®®'® Steri le' nrcw®.aar.vrnOl c 1 rl�t4.rAIlYt7P•r'LrPfM rveJwtOC
<br /> ®+® r mecnna wope,ab�y espc AsE OF EMERQENCY CONTACT;OHEMTREC 1 STAN®ARD MANIFEST dot-lo ce sm
<br /> R(Mte' ;Ila 302 — 27 culatome 21132 1Kt)FR009
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<br /> I.Generator's Name,Addreu and Telephone Number
<br /> ATTR: �AM :�t:t��rOMa�c�n� : ; ; � . : ; .; . '•;;.
<br /> RFIM
<br /> 410 FAS NIECA C ANTE
<br /> .A, CA 95336— 3167
<br /> (209) 239-1.222 9f > ✓2111('.'
<br /> Cuaromm Nueteea 60594777-002
<br /> GEMRATOWS REvtsraartow N
<br /> 2A.DESCRIPTION OF WASTE 2®. CONTAINER TYPE
<br /> UN3291 Regulated Medical Waste,MOS., 2C.No.OF 28. VOLUME
<br /> 6.2,PGII TW7 - 44 Ga3. Tib (Eric) (12CUit) CONTAINERS
<br /> UN3291,Regulated Medkal We6te,n.o.s., TS49 _ �7 �� , (10 Cu.F
<br /> 6.2,PGI, ) (4.9 cu tt)
<br /> O623291,Regulated Medial Waste,n.o.s., T1114 - 44 Gal T»lb(t3al.r�) .Z�.� ou [.t) pp Cu F
<br /> UN3291 Regulated Medleai Waste,n.o.s.. 3.fsiRa o cu 6.2,PGI,
<br /> UJ UN3291,RaQulated Medial-Wage.n.o.s., Cu F
<br /> W
<br /> 6,2.PGI, S 2e 062. TUb (Pa't'h) 62.7 Cit ft)
<br /> 5 UN3291 'Regulated Madicei Waste,n.o.s., Cu F
<br /> 6.2,PGII TY15 — 20 gal Tub Wb ) (2.7 cu Et)
<br /> UN3291 Regulated Medical Waste,n.o,s., Cu F
<br /> 6.2,PGII
<br /> UN3291,Regulated Medical Waste,n.o.s„ Cu FI
<br /> 6.2,PGII
<br /> OUR
<br /> A>PiaR�,BC.@Ut�.C'd.7. Kdectaa
<br /> S.Generators CertHleatlon;"1 hereby declare that the contents of this consignment are fully and accurately 'TOTALS'
<br /> deecribad above by the proper shipping name,and are classified,packaged,marked and labelledJpl riled,and CU Ft
<br /> are In all respects In proper condition for transport according to eppIlcable international and nations em a �I rreg�l tions:
<br /> Printed. . d Name <,�
<br /> 81 tura Data
<br /> CTRANSPORTER 1 ADDRESS:
<br /> Phone#: 65) R D
<br /> rz Stakr1GyclB, Inc. Applicable Perrnlf Numbers;
<br /> 413b West Swift. Ave. ,
<br /> r>t�O,Ca 93722 This is a 11(tangh
<br /> TRANSPORTER CERTIFICATION:.RRecelpt of madiical waste as dest:rlbad above..
<br /> PtiriUrype Name k?• .P � '•�� r?'"*� Sinatur® 1 sv;
<br /> g -,.Dale /O'
<br /> u S.INTERMEDIATE HANDLER 2/TRANSPORTER 2ADDRESS: Phonri'k' • ;
<br /> Applics616 Permit Numbers,
<br /> 5 'INTERMEDIATE HANDLER/TRANSPORTER CERTIFICATION: Receipt of medal waste as described above.
<br /> Print/Type Name Signature Date
<br /> r t3.INTERMEDIATE HANDLER 3/TRANSPORTER 3 ADDRESS: Phone o:
<br /> Gs ..
<br /> Applicable Permit Numbers:
<br /> 3la
<br /> INTERMEDIATE HANDLER/TRANSPORTER CERTIFICATION: Receipt of medical waste as described above.
<br /> i=
<br /> Prinu Type Nam Signature Date
<br /> 7.
<br /> D'*
<br /> I FIEPANCY INDICATION
<br /> U.D'eslgnated FooIllty 88.Alternato Feellity: 08C,Attemate Fadllty: 8D.Alt®rnata Faclilty:
<br /> Irlts-h Inti I 1n6
<br /> 41V W. FT'AVE N 11831'! t C 2"dr.13 SM STPJW
<br /> PR O,CA 2 N T I�AKI!WY,U1' .CA 577 " CA
<br /> CSS 275• (gal). - t (610) .1741 ,
<br /> T931,T3101S725
<br /> Y 1ridnerahlon PwrdW 91102.
<br /> 1 Q2e.p�-1'.16 .
<br /> TREATMENT FACILITY: I certify that I have been authorized by the applicable state a n6 to a
<br /> received the above indicated wastes in accordance with the requirement outlined in that euthoriza�nt Gntreat®d medical wastes and that I have
<br /> PNnI/rype Namo fI ature Date
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<br />
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