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11/12/2010 14:19 209239dD1Q BUSINESS OFFIC PAGE 29 <br /> MEDICAL WASTE TRACKING FORM NUMBER <br /> ® <br /> 6 SteAcycte' IN CASE OF EMeftrANCY CONTACT_CHEWREC 1- 234-0057 STANDARD MAwFEIO oui-ip-waTm <br /> • k: Route 0= 301 - 25 CtM2n=C 800-924-4300 MOFROO99ER <br /> 1.Gemratoes Name,Addresp and Tekphcme Number �I <br /> �lT1rN: C�hylP9laxane <br /> � ACARE & <br /> 410 EASIVOOD AVE <br /> P%NWCA,, CA 95336— 3167 <br /> 1 (204) 239-1222 4/15/2010 <br /> I <br /> 1 CusroaSwrl 6059477-002 GWvs1AM"REereronAnarA <br /> 2A DESCMPTION OF WASTE 26. CONTACNERTYPE 2C_NO,OF 2D., - VOLUME <br /> REGULATED MEDIM wASTE n.o, .6.2, CONTAtNeps <br /> i aT®S7 - 90 aal tub (eaof (L2 cu ft) <br /> UN 3Cu R. <br /> x91 IK;II <br /> REGULATED M€OICAL tAfASTE.n,o.s..6.2 TB49 - 37 643 Tub (Hie) (4.9 CuTtl <br /> UN mi.PG if Cv FL <br /> CC REGULATED Ki)ICAL WASTE..n101s,.62, x914 - 44 Gal 2ttb(Pjo) (5.9 cu tt) �1 <br /> O UN37,41,PG11 //�. 1 <br /> Q REGULAT;O M'DICAL WASTE,n,o S.G,2. - IAa® cm <br /> 1E UN 329',P6 II Cu F t <br /> w REGULATED MEDICAL WA5`6i n.a,e.A2. TSLS - 20 Gal Tub (Paas) (2.7 cu ttr <br /> j W UN 3291,PG II CU Eh <br /> ,Lr) PEGULATEDMEOICALWASTE, TY.L5 - 20 Taal (Gheec,) (2.7 cu tt:) <br /> UN 3291,PG 11 Cv Ft. <br /> REGULATED MEDICAL WASTE,a.a.9-6.2, <br /> 2N 3291.PG 11 Q F <br /> REGULATED MEDICAL WASTE.n.a.s..6.2. <br /> UN 3291.P'611 _ (U FL <br /> Phar]§ACOutieAl WaSte- <br /> 3.GenerMar'o ConiMmIlow h heigby declare Ot91 the eonterns ai'Ns consignment are tully wW amrateN ]TOTALS /�.�1 CU Ft, <br /> dosarlded., awYe by the ompe "Ping namo.and aro claoaftd,padtagod,marked and Iabe ,and .. <br /> N rnnnwNs in p Cern(tips W trtngnart. Inq M Appticwhre Intemesfvnel and nation 1M a <br /> • r <br /> moyTyp40 Na <br /> ANSPORTFR L AR�^aS: Mona a. (559) 279 — 0994 <br /> CC W.CC5 �CxC�rC1C. inc. ApplicMa Pwmii Niortbow <br /> 4135 Trla!IL Swift Ave< <br /> a v Ftesn®,Ca 93722 This is a Thzuuyle 5h9 pment <br /> �a. <br /> Ix d TRANSPORTER CERT FICJ4TlO(+9: OCabt of rnFldical waato as dascrlbed <br /> S.IN-ERVFr%?ATF HANnt FR 7 RANSPORTER.1 ADDRESS: Phonn A: <br /> Ar,II=H a Pnrrrm0 NtirTtww, <br /> INTERMEDIATE HANDLER f TRANSPORTER CEFMFICAnON:R64mipt ct mmli al wml� v dcrib-�d z*vm <br /> PrioVTypo Namo Signature _,._�. D010 <br /> ! ¢ D.INTFRMFOIATF NANr)I.FR 3 7 TRANSPgRTEP.3 ADORFAR. Ptrann A <br /> Ogg w ADpit abbe Permit Nwntmrs: <br /> W <br /> M�X INTERMEDIATE HANDLER/TRANSPORTER CERTIFICATION'Rmmlpr M mndkal wnwo ar rkx7iwad sttnvn. <br /> E7E-' PrInVlype Nana Slpnalure Dale <br /> 7.MSCREPANGY INUCAION <br /> Transfwrad mniainers, cu R M : North Soft L .UIQ' <br /> 13A.DulgnG9od Ftwt4ty: rI so.fiawr n Pncmty; HC.AI*W--M FmWty: 80.AkmnrtA Pa4iefly: <br /> STERICYCILZ INC STERICYCIE INC STERICYCLF INC STERICYCLE INC <br /> 4135 W.SWFT AVE 90NOR7W t leo V EST 9063 NORRIS AVE, 2776 E 26TM STREffr <br /> •max �� FRRESNO.CA 93722 NOM SALT LAKE CITY.UT SUN VAUEY,CA 11352 VERNON,CA 9111)23 <br /> (559)275-13994 (8G 9)an- 1555 (Big)50 4-6537 (323)362. <br /> TS31,smST25 TS/OST22 Classy RrtdT1eMon PewO 31- P-6.P-116 <br /> a <br /> CE i TREATMENT FACILITY: I certify the'I hmm been authorized by the npplicab 110 10 2CCeDt UnRr4arr.!d medral waste,and Imrst I havr. <br /> 1 rpewiVPd the ftbnvs Indica wager.in accordAnee with the retluirem uned in n. <br /> 6`6nUtypq Narno Slgnaturo � Data _ <br /> Ot 00-1 9 <br />