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<br />io Stericycle' IN CASE OF EMERGENCY CONTACT; CHEMTREC 14W"24-9300
<br />Route 1i; 1.25 — 9 CUSTOMER N0.21132
<br />1, Generator's Name, Address and Telephone Number
<br />ATTiTElwai11 Baughman
<br />KKl/1115GlvIl' i IED[CAL PL/\ZA1
<br />2505 V1/ HPAvIlviER LN
<br />STOCKTON, CA 06209-2830
<br />/7AAl r:'79 -P,(107
<br />STANDARD MANIFEST 001.03.21•NOCA
<br />M171FROOP}C:("1
<br />t119A/9n91
<br />CUSTOMER NUMBER GENERATOR'S REGISTRATION �
<br />2A, DESCRIPTION OF WASTE
<br />26. CONTAINERTYPE
<br />20, NO. OF
<br />20. VOLUME
<br />UN3291 Regulated Medical Waste, n,o,s„
<br />Stericycle, Inc, (Autoriave)
<br />CONTAINERS
<br />Starlcycla, Inc. (Autoclave)
<br />6.2, PGii
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<br />41NPC W %-AftAva
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<br />UN3291 Regulated Medical Waste, n.o.s„
<br />—9EATMENT FACILITY: I
<br />that I have been by
<br />IIVI`Ll1'I LU
<br />6.2, PGII
<br />certify
<br />authorized the applicable
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<br />UN3291 Regulated Medical Waste, n.o.s.,
<br />6.2, PGII
<br />Delved the above Indicated wastes in accordance with the requirement outlined In that authorization.
<br />Print/Type Name
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<br />UN3291 Regulated Medical Waste, nxz,
<br />Trgii 6yrod _ toriloinoro-
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<br />6.2, PGII
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<br />3. Generator's Certification; "I hereby declare that the contents of this consignment are fully and accurately TOTALS / Cu
<br />described above by the proper shipping name, and are classified, packaged, marked and labelled/placarded, and
<br />are in all respects In r tlon for transport according to applicable International and national governmental regulations"
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<br />4. TRA PORTER 1 HESS: ��,� Phone #:
<br />Stericycle, Inc. ; j This is a Through Shipment Omit mbe -7422
<br />Applicable Pe mil tubers;
<br />a 4135 W. SwlttAve Hauler ROg1fi 3400
<br />Fresno,CA83722
<br />TRANSPORTER CERTIFICATI N: Receipt of medical waste as descriIkL
<br />PrInUType Name Signature Date
<br />S.INTERMEbIATE Nb 2 TRANSPORT 2ADDRESS; Phone fl;
<br />Applicable Permit Numbers:
<br />INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Receipt of medical waste as described above.
<br />' Print/Type Name Signature Dale
<br />B. INTERMEDIATE HANDLER 3 / TRANSPORTER 3 ADDRESS: Phone 4:
<br />Applicable Permit Numbers:
<br />zINTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Receipt of medical waste as described above.
<br />Print/Type Name Signature Dale
<br />aA. Deslgnatsd Fecilky:
<br />U 00. Allemate Facility:
<br />U 80, Alternate Facility;
<br />Co. Allemale Facility:
<br />Stericycle, Inc, (Autoriave)
<br />Sterlcycle, Inc. (Incinerator)
<br />Starlcycla, Inc. (Autoclave)
<br />Inc.
<br />41NPC W %-AftAva
<br />90 PJ, Foxbnto IJrlvo
<br />1:51 SMAltan Qrivu
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<br />ride."". C: % 00722
<br />H1 rrth Cokit Lott*, UT 84904
<br />Hrj111aTrjr, CA 05023
<br />rbukn, OR 57305
<br />$
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<br />(401 }93C-1171
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<br />(505)39-j-0890
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<br />—9EATMENT FACILITY: I
<br />that I have been by
<br />IIVI`Ll1'I LU
<br />certify
<br />authorized the applicable
<br />state agency to accept untreated
<br />medical wastes a..tA� thabihave
<br />Delved the above Indicated wastes in accordance with the requirement outlined In that authorization.
<br />Print/Type Name
<br />gnature
<br />Date
<br />Trgii 6yrod _ toriloinoro-
<br />T/(/"'cu ti to : Brooks, OR
<br />iTarlsilitrcd _ colitalilo a, Y
<br />_ cu ft to : N. Salt Lako, UT
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