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wi + 0_ 24-Hour Emergency Phone Tracking Document Number: <br /> \ 1►� 01 Number: 888-785-7225 <br /> AST ` <br /> Medical Waste Tracking Document <br /> enviro <br /> W.a me:Facility Naontact Nrite: <br /> Manteca UNfled School District(East L �an hip �I) Kimbedy WHgbt <br /> W cc <br /> LU Address: 1700 N UNon Road Phone: <br /> MaMeca, CA 0337 70M.25=0 Gn <br /> Cont. Estimated Actual <br /> Shipping Description(s) #of Cont. Type Size Weight Weight "Treatment <br /> UN 3291, Regulated Medical Waste, N.O.S. <br /> 6.2, PG II <br /> UN 3291, Regulated Medical Waste, N.O.S. j <br /> 0 6-2, PG II (Pathological Waste) E <br /> I <br /> UN 3291,Regulated Medical Waste, N.0.5. <br /> LL 6.2, PG 11 (Chemotherapy Waste) <br /> z <br /> c� <br /> ? Non-Hazardous Pharmaceutical Waste <br /> IL <br /> IL <br /> s <br /> m <br /> Non-Regulated <br /> Other(specify): <br /> "A=Autoclave, I=Incineration,M=Microwave <br /> Advanced Chemical Transport,Inc. CA Hazardous Waste Registration:4026 <br /> 1210 Elko Drive,Sunnyvale,CA 94089 EPA ID#:CAR000070540 <br /> W= Motor Carrier Permit:0194741 <br /> 0 <br /> ❑ 1210 Elko Drive ❑ 2010 Mission Ave. 265 Riggs Avenue ❑ 13722 Carmenita Road <br /> C Sunnyvale, CA 94089 Escondido, CA 92029 Merced,CA 95341 Santa Fe Springs,CA 90670 <br /> a° 408-548-5050 760-489-5600 209-722-4228 714-545-2191 <br /> ftf~Z MWTS Permit#T -42 MWT P rmit S 1130 MWTS Permit#t TS-8 <br /> Print Name: I0 —�refk164IQL9tSignature: Date: ;"moi b <br /> LU <br /> a Name: DOT#: <br /> 010 Address: State Transporter#or Permit: <br /> 0 <br /> Print Name: Signature: Date: <br /> * I hereby dectare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> 0:o marked and labeled,and are in all respects in proper condition for transport according to applicable governmental regulations. I certify that this shipment does <br /> e not contain regulated hazardous and or radioactive waste. I am aware that there are significant penalties for submitting false information including the possibility <br /> S2 of fines and imprisonment. <br /> LU!l <br /> W fI r <br /> Signature: Print Name: Date: <br /> ❑ Advanced Chemical Transport ACT Medical Advanced Chemical Transport ❑ Advanced Chemical Transport <br /> 1210 Elko Drive 2010 Mission Ave. 265 Riggs Avenue 13722 Carmenita Road, <br /> LU 0 Sunnyvale,CA 94089 Escondido,CA 92029 Merced,CA 95341 ,S�f ggsr�GA-pp670 <br /> Go <br /> 408-54B-5050 760-469-5600 209-722-4228 A J-l LLJ <br /> Z4 MWTS Permit#TS42 Permit a TVOST-66 MWTS Permit#TS-1013 MWTS Pemrit#TS-B <br /> N <br /> THIS IS TO CERTIFY THAT THE WASTE IDENTIFIED ABOVE WAS <br /> RECEIVED AT THE TRANSFER FACILITY CHECKED ABOVE. Signature&Date: <br /> ❑ ACT Medical Healthy ise Services Medical ❑ Waste Management Healthcare Other <br /> Z 2010 Mission Road ! Waste Disposal Solutions <br /> G Escondido,CA 92029 4800 E.Lincoln Ave 4280 Bandini Blvd <br /> 760-489-5600 Fowler,CA 93625 Vernon,CA 9005B <br /> ?V Permit TS/OST-66 559-834-3333 323-307-13514 <br /> in Q Permit#TS-39 Permit#T&OST-81 <br /> LU" <br /> G THIS IS TO CERTIFY THAT THE WASTE IDENTIFIED ABOVE WAS <br /> RECEIVED AT THE DESTINATION FACILITY CHECKED ABOVE. Signature&Date: <br />