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nx trate/time NAY-25-2011 (WED) 15: 35 P. 043 ` <br /> 05/25/2011 WED 15: 56 FAX ®043/044 <br /> •ss steH e. <br /> lt <br /> �• ���� � CASEOFt:MERCiEreCYCONTACT:CN2=1YtiRf:Ct•AOG�42s•934e �AkluaReluaFESrcorro-otFsip <br /> Route �: 913 -0Cum 0�e�1�ti.[t0.l� Tr t"`(l�Ts <br /> t.Generator's Name,Address and Telephone Number (( !�II ii (I ff!! r <br /> eyv- <br /> ATiN: Gayle Moses 111111 its III <br /> BIO/LORI MEMORIAL FEST CAMPUS <br /> 800 SOUTH LOVER SACRAMENTO ROA <br /> LODI, CA 95242 <br /> (209 339-7668 I I <br /> cusrvrFn tV� li Q 4 t1 -t�t?� G�'Ivr+a�e <br /> 2A.DESCRG"MQN OF WASr6 28. CONTAINER TYPE <br /> W <br /> y 2C.t{0.OF 20. VOLUME <br /> tp <br /> AP.�S - BioS terasS � �A takdMetAcat =_ V"s <br /> YItaxgs Tr=.- Cart (59 cu £t) Cu Ft H'a�e,n a.s. <br /> vsteo: Tt'xnsport Box ('.7 cu ft) <br /> lZ tiN3291.ReplIaue Medlral Haste,n a s Cu FL <br /> 0 6z,Pan <br /> Q <br /> MR 1 Rlpldated Mesial W3sle.0,0.6. FL- <br /> 6Z <br /> PGI <br /> 1 <br /> W UN3291 RepWed Medical Write, <br /> 1Z V.P611 <br /> {9 tt1ua291.Regtdaled Metrical Waste,a.o,s. Cu Ft, <br /> 62.PGfI <br /> UN3291 Regubled Medical Waft.aos.. Cu Ft. <br /> 6.2.PGII <br /> 11fNl ltepulated Nledltal Waste,A.Os,. F <br /> 8z.P611 <br /> PhaRiWceullcal Wa6te Ft. <br /> Co F <br /> 3.Generators Certification;h hereby declare that the Oontenle Of this consignment are fully arrd aoeuretety TOTAL$ � r <br /> described above by the proper Shipping name,and are classified.padnag9d,rnarlted and ltibellodlpltuearded,end Cur t <br /> ora in an wspeCla proper ✓tion for transport avcordng to app=ble Intemaliona!and Aadonaf <br /> t - � Rim �� ' <br /> Ped� Bnatwe Date <br /> 1.'rRANSPOR7EFi t ADDnESS: . <br /> Phone��k�:1�� <br /> aAppiKeoze�simitlYirnrbers;5506 <br /> ]1875 White Rack 13d <br /> MR 8'1'irRICYCLE This ie a Through Shiptsent <br /> a TRANSPOF !waste a:desutbed a <br /> Prinvrwo Hamm Signature Data <br /> n <br /> 5.INTERMEDIATE HANDLER 2/T POFM 2 DRESS: Phone <br /> Applicable Pertntt Numbers: <br /> INTERMEDIATE HANDLER/TRANSPORTER CERTIFICATION:Aeceitu aI rnedicel vra5la es deseribetl above. <br /> l'rint/iype trema S"ture <br /> Date <br /> La <br /> e.INTEFiMEQlATE NANDLI;R 3ITRANSPORTER 3 ADDRESS-. Phone e: <br /> gig <br /> ApplicaWa Permit Numbers,. <br /> 9 INTERMEDIATE HANDLER/TRANSPORTERCERTIFICATION:Receipt Of medical waste as described above. <br /> Pifntrtype Name Sipnaiure <br /> ate <br /> 7.DISCREPANCY tNQtCATt4P3 <br /> i Trai!ERCYC!C. <br /> d iners, I '�cu ft to : North Salt lake, UT <br /> } O8A Oeslpnated feellhyc Atlorturte Foci tt ; 8O.Altsmate a ST7~F�IGYCI lw.ING. STERICYCLE,INC. STERICYGLE,INC. <br /> !Sas hnnrirrtP nrrva Shirr t 4135 W.WtAvenue 90 Nordt 11(18 West 1612 Starr Or <br /> S9n t aandm nA [14677 Frohn i'.A Q.1727 <br /> w (51 Q1582. 1781 N",Sats Lake UT 84054 Yuba Cil,CA 95991 <br /> T�i.tt.rT Z (5591275.0994 (801)938- 155 (539)756%0585 <br /> P4 TSIOST?2 Class V In nagff� <br /> P-9,P.115 <br /> ALE AAN� <br /> TREATMENT FACILITY:t certity that I have been authorized by the applrca fe state agency to accept untreated medical wash an-1 that r ha.ge <br /> recehvr d thefabeve,irldicated wastes In accordance with the requirement Outlined In fill that authorization. <br /> Prin"ypetWma{ y 5ipnalurm—_ <br /> 100022 <br />