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Ingenium Group LLC <br /> 955 W. Mission Avenue In <br /> Escondido. CA 92025 Doc# t "' <br /> 893 Ames Avenue geniume <br /> Waste In. Green Out. <br /> Milpitas CA 95035 <br /> PH: 760-745-8780 <br /> FX: 760-745-8786 MEDICAL WASTE TRACKING DOCUMENT <br /> Generator/Address: Contact/24 Hour Emergency Phone # <br /> i i ahoratory CAL000040030 t'�Qf1E: <br /> 800-533-8253 <br /> Transporter 1: Transfer Station: (If Applicable) <br /> Ingenium y ,+arrrer�io <br /> 2280 Micro Place, Escondido, CA 92029 tiUU3 Foodlink St <br /> DTSC Hazardous Waste Transporter Registration#4857 ;acramento,CA 96828 <br /> 800-805-6236 <br /> Designated Disposal /Transfer Facility: (Check One) <br /> ❑Medical Waste Services ❑Healthwise Services ❑Healthcare Environmental Services ❑Curtis Bay Energy <br /> 7321 Quimby St. 4800 E Lincoln 1420 40th St. NW 3200 Hawkins Point Rd <br /> Paramount, CA 90723 Fowler, CA 93625 Fargo, ND 58102 Baltimore, MD 21226 <br /> 888-610-1311 855-246-9473 701-282-7373 410-354-3228 <br /> Permit#:TS/OST94 Permit#:TS-89 Permit#:T5/178001 Permit#:2005-WMI-0036 <br /> Shipping Information: (Treatment Code: 1=Incineration, M=Microwave, A=Autoclave <br /> ✓ Description Count Cont. Type Est. Wt. Actual Wt. Treatment <br /> UN 3291, Regulated Medical Waste <br /> 6.2, PG II (ERG#158)/B10 <br /> UN 3291, Regulated Medical Waste <br /> 6.2, PG 11 ERG#158/BIO INCIN <br /> UN 3291, Regulated Medical Waste <br /> 6.2, PG 11 ERG#158 PATH <br /> UN 3291, Regulated Medical Waste <br /> 6.2, PG 11 (ERG#158) CHEMO <br /> Pharmaceutical Waste <br /> This is to certify that the materials described above are properly classified, packaged, marked and labeled and are in <br /> proper condition for transportation in accordance with the applicable regulations of the United States Department of <br /> Transportation and the State of California. <br /> Generator: <br /> Name(Print) Signature Date <br /> i <br /> Transporter 1: <br /> [—Name(Print) Signature Date <br /> Transfer Station: If Applicable) <br /> Name(Print) Signature Date <br /> Designated Disposal /Transfer Facility: <br /> Name(Print) Signature Date <br />