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ReturnTralpgo- <br /> Received <br /> Date: <br /> Treated Clete: � w <br /> er <br /> ld Date: <br /> Manifest Image <br /> Name: Meghan Weisel <br /> Signature: <br /> kN6-,-,o w, A <br /> Date Received: 11/1/2018 <br /> Date Processed: 11/5/2018-AC <br /> Weight: 54 lbs. <br /> Facility: HCA <br /> 1111111111110111 <br /> .Compliance, Inc® _ 3797247 <br /> TakeA ayTm Recovery System Tracking Document <br /> Complete sections 1 through 5 on this triplicate form.Keep"Ship r"(bottom)copy of <br /> completed form for your records,place remaining copies In the plastic pouch on the outside of <br /> the box. For detailed instructions,information regarding contents,and training purposes,see <br /> Packaging and Shipping instructions enclosed in this shipping box or visit our Website at <br /> www.sharpainacom. <br /> All items below must be filled out completely. <br /> 9. h'ocet's orintgA asaA,sWafttit <br /> Hard Luck Tattoo <br /> 7 N Sacramento St <br /> Lodi, CA 95240 <br /> d 0030 <br /> 6(J m <br /> Contents:Used or RhapVor tat <br /> 4.Dsle <br /> � 2 Gtip/ Used Hsaahcaro M®MotoristseMotoristsS ur <br /> 9. per f".a• $ox(r+..............................._.....s.�•_•.•- <br /> 4 reena tie rrrtvao o S. ego lie la esl- <br /> TRACKING FORM(MANIFEST)DIRECTIONS FOR SHIPPER <br /> Chock above.viverything must be filled out completely.YOU MUST SIGN#3 ABOVE. <br /> Keep"shipper"(bottonn)copy for your records. <br /> Make sure#3 Is signed and#4 is completed with the date containerwas shloped. <br /> Put this Tracking Form in the provided ziptock beg on the outside of box and seat <br /> CComments <br /> i <br /> I <br /> { <br /> 'T'O BL COMPLETED BY DISPOSAL SUE ONLY <br /> Printed certification of receipt andprocessing:'I certify that the contents of this container have beca <br /> received,treated and processed in accordance with aA local,state,and federal regulations." <br /> 'A'reatraeat)F'acitity-. ue�x�tox�ruri tmt:. �ttns tsaaltr <br /> U stmrpm a6; ira nenW 9ervicea.Inc. fl II&XIChWhe <br /> 19"Nig 7.0op 4800 E.lAncotn Ave <br /> ca -ix 7s6ss cngag _--- <br /> te Pio.40267 7•..v a..t 2,O. <br />