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06/17/2011 FRI 12: 15 FAX yVlt " "` r ac. uJ K094 <br /> • 0 ots SLerlcydu' 0004/028 <br /> R&PeVF%Alf W Coxra:CT:a rrMC 1,6oD.Q W 14DACC .-2 r.n"P°°'iota m <br /> 1.Gerttif:3tEar'a Name A �Rfta.ntzt <br /> tidres+9 artd Teleptt: rm Number <br /> ATTH: Gyle Maser, <br /> BIO/LODI MEMORIAL HOSPITAL <br /> 975 SOUTH FAIRMONT DRIVE <br /> LODI. CA 95240 <br /> (209) 334-3411 516/2013 <br /> 6089077-002 a ,,,,, �� <br /> vreQ7rofWAVMcamtowl f <br /> rpg <br /> tta>�t� S;aS tela 5 r. lf:LFL P= h"Ps Izeas Cast (S9 cm ft) <br /> MPH nos. g - 8fa9Vstetnv 9'ranap*sr box (4-2 cu fW <br /> Q6Mm1 RWtt W>st;e>os. CUFL <br /> Btj Mit Nhsta ao s Cu <br /> �z tltD28t t+Vasu,aos <br /> W 62,PGRFt. <br /> (7 ILZ l 9 C mid m Waste.0.as., <br /> Cu F <br /> Mgt RepuWMtftWa7tp,e.0.8� fu <br /> sear <br /> 7.Oaner Wo CWMMh,,9 hmeby dedme Cent!ha Mftftof thIS • <br /> 90 0*0�0'e prober .arw are etaeatAed.Aat:kaped�a d ra�be� TOTALS► �/ <br /> respem t Y lron for p0nspat !nA to eDOpaebte htemaCorent AM nettle n,as d p Ce FL <br /> I ,'Prtrred�Na r' <br /> ..TRANSPORTER i ADDRESS: Dara�r6 L <br /> aPfnee y t <br /> 11875 Whits Rook Rd APP IeJ�rrntthhreemem <br /> STERICYCLE 0 %ift is x Through ShipmeTat ••� <br /> IL a TRANSPCRTt�* t <br /> waste ss mea Rei!f 3400 <br /> B.ItITER]NEDLArc MANDLER 2/TMN PORTER 2 ADt)RF.SS: Die V r6- <br /> n <br /> Phone&I <br /> Awksbre Pom*Njaftw <br /> INTERMEDIATE"NOM/TRANSPORTER CE <br /> RTIFlCATION:Racetpt d medke!rraale ea deeal6ed above. <br /> Prtnvrrpa Mena <br /> �aua Dma <br /> B.piiZ RM pIA1E rVW4L tH 31TRAN$PORTER 3 At=ES9: <br /> Pt+onO a; <br /> IPMRMEOWTE HANDIER/TRAM 'Peree�q ft :a <br /> r SPORirER CERTIFICATION:PAWWt of rnedW waste as d*WAW&Wm. <br /> PrM�rrYpe Herne <br /> ------------------- <br /> 7.oiSCREP.WCY 1ND CATtOt�r �Aue add` <br /> Tram ed�cantalnerB,2Bou R tO : NOM Salt lake,LST' <br /> ❑6A Dastpeuue Fado r: <br /> Aftff��� fR1 <br /> 5"�ERICYCLE.ENC. <br /> 1345Doolittle SMSUCYCLE.INC. CLE INC. STERICyCL.E.INC. <br /> Drive.SuiteG 4135 K SwA Avenue100�hlastSan Lesndro,CA 94577 Fresno.CA 93727 1017StarrDr <br /> (5101 82 ,f�7B> O (5581775-0984 Lake,UT 84054VUba Crtv.CA 95891 <br /> 7531.`# ? �.» -1555531Ij 765•Q595 <br /> pqt E d]rera'kon�untreatw <br /> Perm 91 S/OST 8F1tREATMINT$F �1I have been authorized9 acereceived the medlceeT wastes and that 1 haver <br /> waste3s In aexor,sance whit the regttlreenant Outllnetd in that authorization, <br /> P+dntl"NameA�4``�V ••" <br /> Aid�Lls:, r�ie • <br />