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11/12/2010 14:19 20923942L9 BUSINESS OFFICE PAGE 30
<br /> MEDICAL WASTE TRACKING FORM NUMBER
<br /> ®®®, Storkyde, IN CASE OF EMERGENCY CONTACT;CHEWMEc 1.8o0-7344051 STANOAHu MANIFEST 001-WMSTD
<br /> "'""ftt*.'-"Rkk-. Routa 9: 301 - 20 CHENTPEC 800-4'14-9300 MDFR0097KD
<br /> I_Generators Name,Address and Telophorre Number I I
<br /> ATTN: Cathy/Maxine
<br /> MA WrECA CARE a 7tEBAB
<br /> 410 EASTWOt3D AVE
<br /> 1"AKIZCA, CA 95336- 3167
<br /> I • (209) 239-1222 9/]/2010
<br /> i
<br /> CL#SMMBR NUMBCR 6059477-002 0134ERA-MR'B RFA9TRATiON®
<br /> i 2A.DeSCAHMON OFWAST6 2s. CONTAINERTYPE 2C.IND.Of. 2D- VOLUME
<br /> REGULATED MEDICAL WAStE,n,o.s..6.2, 7CB5? - 90 paJ, Tub (Bio) 112 au ft) CONTAINERS
<br /> UN 3291,PG it Cu Ft.
<br /> REGULATEOMEDICAL WASTE.n.o,S..6.2, ^5949 - 37 Gal Tub (Elio) (4.9 cu 1:t) -�
<br /> UN 3291,PG 11 ___...... Cu Ft
<br /> REGULATED MEDICAL WASTE,0.6.9.,6.2, TDIA - 44 Gal Tub(ftol (5-9 CN t:C)
<br /> i Q
<br /> UN 3291,PG 11 Cu Ft,
<br /> REGULATED MEDICAL WASTE,r..o.s.,6.2, TB21 - 20 Gel 'duh 091-0 (2,•' nu it)
<br /> CC ON 3241,PG 11 Cu FL
<br /> IM REGULATED MEDICAL WASTE,n.os..6.2, TRIS - 20 pal Tub (Path) (2.7 Cu ft)
<br /> WCv FI.
<br /> UN 3291,PG It ...
<br /> Q� U1=n u1FDlrnl WASTE,n o- 62, T-rlS - 20 gal Tub (Chem*) (2.7 cu ft)uN 3791.PG a cur•L
<br /> REGULATED MEDICAL WASTE, -
<br /> UN 328t.FC-11 Cu Q.
<br /> REGULATED MEDICAL WASTE,n.a.s.,6.2,
<br /> UN 3291.PG II „// Cu Ft.
<br /> Rbarmaceutj,cQL Waste 1% rA r -C C..><l� _.� l ° _ Ff.
<br /> 3.Generator's C®rt@flemioM I hereby de dam Mad tho ta=nk of oft cOnSl mwI are fully and atmuralely T0T ® 0 Cu Fy
<br /> tifteMm abo”by the propor shlpM%;name.sntl ane classitied,mcksood.marked and tabelted/placameu, d
<br /> neo in nIi r�5pacts in p t`OnA'iftm for te'gfte n°l Aaeordlnp tto1aap IoW iMemglionol ped n1tl�npt yovq
<br /> "qr
<br /> IPrintedfPypad Name AL&
<br /> ._.. ��71r-s! Si azure D819
<br /> 4.TRANSPORTER 1 ADDAESS: 9hOno re: t5J9j '2W _ 4994
<br /> StericyCle, Inc. AONKaWoPermitNumbers.,
<br /> 4135 West Swift Ave.
<br /> q 4 This is Throu h Shl,f.mPnt
<br /> Fseano,Cm 93722
<br /> L16;C
<br /> TRANSPORTER CERTIFICATION: Remipt at lnedleal waste/.rcdbml fthovn. r
<br /> 0
<br /> I PrJnt/Tyj*Nmne C V. 5!®nRtvrts __-...._�.. __ DAIR_..___ .,
<br /> 5.INTERMF..DIATF•HANDLER T,/MANAPQPTFR 2 ADDRESS: Phong e•
<br /> 1 AcplicaMe FbrmR Numbor.
<br /> { il z INTERMED AI)0-'�'E HANDLER/TRANSPOMPt CER' FI0A?I0N:rarrnipt or-exsea:��to tr,dgscribsd above.
<br /> Print/Type Name Signature Date
<br /> etS.INTERMEDIATE HANDLER 3/TRANSPORTER 3 ADDRESS: Phone*I:
<br /> { u Q AMft*W Fern*Numbers:
<br /> w
<br /> INTERMEDIATE HANDLER/TRANSPORTER CEP,fi9lMAP.ON:AOMIPL of TMir-11 &^,CrtCd abcvc.
<br /> ' h
<br /> IN Print/lype Name S grubluro Date
<br /> 7.DISCREPANCY INDICATION
<br /> Tet" d Zewalmrg. 1+ av ft ho : North Salt Lanae,UT
<br /> } AA.Dsalgrstrd FocuRy: $9.AlQemen Pad"! M.A""u"Ftt-Kry; ICj AC.Artrmem Fnemty
<br /> J cRICYCLE INC STERICYCLE;Nk, ISSTERICYCLE
<br /> is AVIS. Z7^6RE 26TL!INC
<br /> 4125 W.SWFTAVE 90 NORTH 1100�cr
<br /> f FRE►N0 CA 93722 NORTH SALT LAKE CITY,UT SUN VALLEY.CA 91352 VEPNON.CA 90023
<br /> i (ml 275-am (80 t)936-13SS (016)&W-6987 (323)352-3MO
<br /> TS31.T=ST2S "I' OST22 � Class V Indnervhon P 91- P.O.P-1 I5
<br /> W h TREA7111ENIT FACIILrrY.-I cert' t t t by Lha apRiN.?hie st3tP agency to arerpt untr!�atod m47dirAl waSles and that I hsvp
<br /> received the above indicated outlinod in that aulhorizallon,
<br /> Sa
<br /> PnnViype Name :ronpturo Data
<br /> APR 13 MW
<br /> ORIGINAL
<br />
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