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rJl!~l)Itt%;{-VVAZ5i t I'MAQKINU FVHM-NVMtiCt
<br /> St01ICy+GIe' IN CASE OF EMERGENC!(,CONTACT-CHP -C t-800.234-0061M{r��yT'yy�J�+'�/ f��j--bTANDAAD MANIMST 001-to•00-ST-D
<br /> #"U0179 hepk.KtAxG'R Route �.�.. "•'1 Mf_�135.•00841Qx
<br /> e3ef ar's Name,Address olid Telephone NumberE # � �l ) .
<br /> • ATTM; Gvl . l�lopeas !I €I !t
<br /> ift" ,
<br /> BIO/LORI MEf l4RIAL, HOSPITAL
<br /> -975__S-OUTH. ..FA:T RMONT__..DRIVE _
<br /> LODI . CA 95240
<br /> '209) 334-341 . 122/2010
<br /> CUSy0A1ER NuMBEn GEf4ERAT0RV8 FtEOWRATION 0
<br /> 2A.DVSCRIPTTON OF WASTE 2B. CONTAINERTYPE 2C. NO.OF 21). YOLUMC
<br /> COtETAi ERS
<br /> REGULATED MEDICAL WASTE,n.o.s.,6.2,
<br /> UN 3291,PG 11 DOT-SP 135t 5 RR65 - T1 kos steWs shl A x Trans Cart 09 cu ft) Cu I
<br /> REGULATED MEDICAL WASTE,0.0..8.,6.2,
<br /> UN 9291,PG II IAB$ r Ha o13V5rern Tranvoort; Box (4.0 au ft) Cu I
<br /> REGMATED MEDICAL WASTE,n.a.8.,6.2,
<br /> UN 9291 PG 11 Cu 1
<br /> REGULATED MEDICAL WASTE,mo.s.,6.2,
<br /> UN 3291 PG 11 C
<br /> REGULATED MEDICAL WASTE.11.0,0,6.2,
<br /> Uhf 3291,PG 11 Cu
<br /> REGULATED MEDICAL WASTE,n.0s,6.2,
<br /> UN 3291,PG 11
<br /> REGULATED MEDICAL WASTE,n.o.8.,62,
<br /> UN 3291,PG 11 Cu
<br /> REGULATED MEDICAL WASTE,0.0.8•,6.2,
<br /> UN 3291,PO 11 Cu
<br /> . A >3
<br /> 3.Generator's Certification:11 hereby declare that the contents of this consignment are fully and accuratelyLS
<br /> described above by the proper Shipping name,and are classified,packaged,marked and labelloWplacarde[ ITOTAand :
<br /> are In all respects In proper iti0n for transporl according to applicable international and nailonal govern stat r ulatlons'
<br /> Printedrfypad Name / Signature date -R
<br /> 4.TRANSPORTER 1 ADDRESS: Phone 0g:: g' g8 _
<br /> AppOMIG P�rmlt Nu ntisrsf p
<br /> 3,1875 Whi.tc Pock Rd FK1 Thisx iv m ThrOugb Sha.}mae.nt
<br /> �rT'tfR�CYC L,3~
<br /> TRANSPORTMGEBURGAEGNi tga ipt 13L5TTedlfxf waste as described above.
<br /> PrintfType Name _ Signature OBIS
<br /> 5.1NTERMEDIA E AAkDLER2(TRA PORT R DRESS:
<br /> 5i:R91I� IifCtiN>S '-,�
<br /> ACCOUtIT 1: 6%90711W �=
<br /> INTERMEDIATE HANDLER/TRANSPORTER CERTIFICATION:Reeeiptof mediealwaste as described above. 0101Lodi 9 wrid Ibspitil
<br /> SIN- VILT..RAT[.: 1122110 7;05:59 M
<br /> PrinVTypeMarne Signature ORI"-IO: MI
<br /> 8.INTERMEDIATE HANDLER 31 TRANSPORTER$ADDRESS: SMI)i'INU DOLU"T 1; ONO&%
<br /> 10TAt C0 UCTEO: 14
<br /> INTERMEDIATE HANDLER/TRANSPORTER CERTIFICATION: Receipt of medical waste a$described above. TDIX VOLOHf; 116.%0 CU FT
<br /> Pdn*pe Name Signature IrrA110 M; 00A00 6 RKOI q)At Kftl Eitlll
<br /> IrrV IFIl Rh'01 MA00K RX8I r711'R 1 OCfli
<br /> 7.DISCREPANCY INDICATION IkOXV RXRI MADRG RX9I ItlfdllA RXI)i
<br /> Tran's rr d containers, /60u Gu ft to : North Salt lake, U Alf,06 PKJI OMWK7 R%QI ,,q'I06 UB!
<br /> U6W9 RXD1 OOAORC RXHI
<br /> Q SA.Designated Faclnty: B.Alternate Facrllty:J 8C.Alternate Feoll{� J/�
<br /> � / SVRAEfYt(:Ixlt Type) QTY C+
<br /> STERICYICLE.INC.^ RICYCI,AIN
<br /> San Le4 6 Dandroc�04677tte C Fresno,CA93722 Ue North$glt I.4ke,UT 64064 KRV'DivSr,tvns SfrhIps Tr:ns i sr�C algl
<br /> r t?. Bq1 036_ i55 RYRt f�l.AIO*•,,,t ial 8000i sy 13 Y, IV11
<br /> I�tfll�i32- 1761 (5,s>��27�,",f��l�INEOtiT �
<br /> TS3i,TSt�JST25 TSIOST AL17tDCLRVE.O ltd IUON iln KNI I: PIM006,d1X
<br /> TREATMENT FACILITY: i certify that 1 have been authorized by the applicable State agency to aacogt untreati TO1W. UfL IGI:Rt:p ITERS: 7.
<br /> received the above indicated wastes In accordance with the requirement outlined in that authorization_ IYK QTY
<br /> PrinVrype Name gn'aEu�e i valb
<br />
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