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► � PureWo <br /> i solo ilii 79 336 <br /> '. TOTAL COM PL I A N C E <br /> PUREWAY COMPLIANCE TRACKING MANIFEST <br /> Please CLEARLY fill in all of your information below. Upon completion, remove the "Generator" (bottom) copy of <br /> this document and retain for your records. Place the remaining copies back in the plastic pouch labeled Tracking <br /> Manifest. Proof of destruction will be posted online at www.portal .pureway.com/login within 10 business days. See <br /> the instructions included with your system for more details and if you have any questions, please call 877.7653030. <br /> 1 certify that all containers within this system have been approved for the mailing of 'regulated medical waste/ <br /> sharps" and have been prepared in accordance with the directions for that purpose. I certify that this system does <br /> not contain excess liquids or nonmailable materials in violation of the applicable Postal Service regulations . I certify <br /> that the contents of this consignment are 1) fully and accurately described below by proper shipping name, 2) <br /> are classified, packed, marked, and labeled, and 3) in proper condition for carriage by air according to national <br /> regulations. LASTLY, I AM AWARE THAT FULL RESPONSIBILITY RESTS WITH THE GENERATOR (MAILER) FOR <br /> ANY VIOLATION OF 18 USC 1716 WHICH MAY RESULT FROM PLACING PROHIBITED AND IMPROPERLY PACKAGED <br /> ITEMS IN THE MAIL . <br /> Contact Name : Flawlous <br /> Company Name : Flawlous <br /> Address : LODI, CA 95240 <br /> Phone : (209) 556-3281 <br /> SKU : 40016 @PureWay 6x1 .4 Quart System <br /> Contents : Sharps Waste <br /> GENERATOR NAME (PRINT) VeA D e3 m4e i r-, <br /> GENERATORSIGNA[T]URE <br /> DATE SHIPPED <br /> COMMENTS <br /> TO BE COMPLETED BY TREATMENT FACILITY ONLY <br /> I certify that the contents of this container have been received, treated and processed in accordance with local, state <br /> and federal regulations. S <br /> TREATMENT FACILITY MANAGER <br /> WEIGHT OF SYSTEM <br /> In case of emergency, or the discovery of damage or leakage, call : 877. 765. 3030 <br /> TREATMENT FACILITY: <br /> MedSharps - 17340 Bell North Drive, Schertz, TX 78154 <br /> Proof of destruction will be posted online at: www.portal. pureway.com/login <br /> While - Trealment Facility, Yellow , Shipper. Pink - PweWay, Goldenrod - Generator <br />