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<br /> 5t©ricycle' IN CASE OF EMERGENCY CONTACT.-CHEMTREC 1-800.234-0051x� STArNOARp MANIFEST oes•sD•eG•5To
<br /> trolaclfM hopfeRelu,Gy lih6; # `412 —4 !'J � ti••• � 1''1
<br /> ,-•.'�
<br /> 1.Generator's Name,Address and Telepfaone N-�1ti1bLr .•••.. '�k�:' .,II€€' . � � '��� ��•��� j � ���f$���€�� � ��
<br /> ATTI,[: Gvle MoSez
<br /> }3I0(10DI MEMORIAL MSPITAL
<br /> A7.5-.-SOUTH--FliI.RMOHT -DRIV..E.. .
<br /> LODI . CA. 95240
<br /> 3 1 8 010
<br /> YUSToman N1IMBEA QeNEilA717n'8 REGISTAA'11ON#
<br /> 7A.DESCRIPTION OF ASE 2R, CONTAINERTYPE 2C, NO.OF 2D. VOLUME
<br /> CONTAINERS
<br /> �GULATED MEDICAL WASTE,n.o.s.,$.2,
<br /> JN 3291,PG II s
<br /> ❑d •SPS K1tGS - B±oG tems Sha s T:casls Cast (59 au Mfr) OuF
<br /> JEGULATED MEDICAL WASTE,
<br /> JN 3291 PG II TSfil3X 8S aSu�tam� 7'zanzj?o t Bax (4-3 cu ft) Cu F
<br /> 3EGULATED MEDICAL WASTE,n.o.S.,6.2,
<br /> JN 3291,PG 11 Lw CU
<br /> 3EGULATED MEDICAL STE,n.a s.,6.2,
<br /> JN 3291,PG Cu F
<br /> It
<br /> 3EG"ED MEDICAL WASTE,n.o.s.,S.2,
<br /> JN 3291,PG 11 Ou F
<br /> 1EGULATED MEDICAL WASTE,n.o.s.,8.2,
<br /> JN 3291,PG 11. Cu F
<br /> 1EGULATED MEDICAL WASTE,n.o.s.,6.2,
<br /> JN 3291,PG II r
<br /> IEGULATED MEDICAL WASTE,n.e.s.,6.2,
<br /> JN 3291,PG 11nc, Cu F
<br /> fi>(SI Ou F
<br /> S.Generator's Certllleauon:•t t e !hal the contents of this consignment are fully and acCutatelyy
<br /> TOTALS �- Cu F F,
<br /> described above by the proper shipping name,and are classified,packaged,markod and labelled/placarded,and
<br /> are in aft aspects in proper ItiGn for Uanaporl acaartfiin to applicable International and national govornmo tal regutallons"
<br /> Prinled/Iypod Namo Signature L Date . _'• t O
<br /> 1.TRANSPORTER 1 ADDRESS: Phone#1:
<br /> AppiicW PdrmIPA&bers:55 Q
<br /> 11875 Whi1;a RoalL Rd 1117:ctattgh shipmcnt
<br /> rRANSPORT 5;ffRTJfVQAT1 131hpcwvngloal wasto as described above.
<br /> ?rinVrYpe Name Signature
<br /> INTERMEDIATE HM LER 2/TRANSPORTER 2 ADDRESS:
<br /> SFAVICE RECEIPT
<br /> ALCUff 1: 6069DTT.
<br /> NTERMEDIATE HANDLER/TRANSPORTER CERTIFICATION:Receipt of medical waste as described above. 81011.odi Remarial Fbspital
<br /> SERVILT:00f.: 116110 7:16:39 AN
<br /> ?anl4ypo Name Signature 0IUM 19: 0
<br /> 1.INTERMEDIATE HANDLER 31 TRANSPORTER 3 ADDRESS: 311114%&WWI` 1: 01AMIfil
<br /> 101A. LT1IYETEO: 22
<br /> NTERMEDIATE HANDLER/TRANSPORTER CERTIFICATION: Recelpt of rnedloal waste as doscribed above, ICTAL VOt.K: 95.(AO CO H
<br /> ,rinVlype Name Signature
<br /> trtAt� i R><I!i tKIA000E RXB1 + aedA 11r',i
<br /> 1001(►fi Pmt 00A00UIl RXBIAXBI :ylirlal0: iF413DISCREPANCY INDICATION [} 6v11441t RltBl (>oA000K =;,tiil4 114
<br /> Ir rTsf d � garatalners, 1_ S cu ft to . North Salt Ieke, UTA o!AcPftt RAI WA00 RXBI .a",°>+;�'4f?
<br /> 4;0(r I'y0t (OAOQt10 RXBI
<br /> BA.DesignatedFatilltyr 8S.Alternate FeellHy: BC,Alternate Facility: ec.--i t R01 11Oti)MTNJ
<br /> fa/ /v ,�.r:� �; r;�Bt "IO[ttf RX61 jfy1;
<br /> STERICY('�E.INC. �iCYCLE.INC. RI alAo�t1 RXBI
<br /> 1345 Dco1 e Drive. Suite C 44 V .SIvaAvenue
<br /> San Leandro-CA 94577 Fresno.CA 93722 Nortl-i Salt Lake UT 84054 stratAm'tt>It I,^Aef ;Liv t
<br /> (510)562- 1781 f650i 275-0994 (8011939 15riv
<br /> � ` TS3�,.7SlClST25 TV GET 22 �t, �1 ci €� 11,�
<br /> -REATMFNT FACILITY: I certify that i have been authorized by the applleable state agency to accept untreated medical wastes and that I have
<br /> aceived the above indicated wastes in accordance with the requirement outlined In that authorization_
<br /> lrinveype Name _ _ S19nature tate
<br />
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