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<br /> 11-00 Stericycle' IN CASE OF EMERGENCY CONTACT:CHEMTREC 1-600-234-0051 :5TANDAnD MANIFEST 001,W08•SttD '
<br /> • ►rpMaina heplt,tedw*y llltL' i^ii�•.rl1y,RLF1'1� f
<br /> 1. Geislarator'sName,Address andTelePhone Number t .
<br /> 1111111111 UNIONS 11111
<br /> Cumiaeft Nuetawi V U ` i�✓ �_ t3e"E"TOR's ReGISTnanoN 0
<br /> 2A,DESCRIPTION OF WASTE 28. CONTAINER TYPE 20. NO.OF—2D. vOLVM£
<br /> REGULATED MEDICAL WASTE,n,o.s.,6.2, CONTAINERS
<br /> UN 3201,PG Il 2r3.4-(P;1ttu) #41 Gell, a2uh (5.9 aws d*t) Co
<br /> REGULATED MEDICAL WASTE,n.o.s.,6.2,
<br /> UN 3201,Pa 11 '1"8Z�-{$d{�} Ti615-(Peds) ! TY,)5-(t`9 w<V) 20 00. Tub (2.7} Cu
<br /> REGULATED
<br /> PG11
<br /> n.o.s.,82 TBGS-(Bio) 1 ?1240-(Pat;21) I TY49-(Cllwo) :17 Oaa Tub (t.19)
<br /> Cu
<br /> REGULATED MEDICAL WASTE,n
<br /> U .o.s.,6.2, TV135 ,_ 2 6 �.*Z Tub (Frio. (3.S Cu ft)PG li •t •�:•.�
<br /> REGULATED MEDICAL,WASTE,rr.o,s„6,2,
<br /> UN 3281.PG It TU57 - 90 lrAl. Tuh (trLo) (3,2 cu tt) Cu
<br /> REGULATED MEDICAL WASTE,.n,o,s.,6.2,
<br /> UN 3201,PG 11 9#Yc6 – 48 0n1 Tub (bio) (G.4 ou ftCv
<br /> REGULATED MEDICAL WASTE,n.cs.,6.2,
<br /> UN 3281,PG 11
<br /> j12u
<br /> REGULATED MEDICAL WASTE,n.os„6.2,
<br /> UN 3281,PG U ST64 - 64 i33 t Tula (Bio; (9.0 t"i ft)
<br /> PhtlrtxttiGslR}Gi1t Watut cro '
<br /> S.Generator's Certification;`L hereby declare that the contents of this Consignment 4m fully and accuratelyTt3TALS ►. , 1
<br /> desorlbad above by the proper shlpping name;and are ctassilled,packaged,marked and tabeged(plaoarded,andCu
<br /> are in alt respects In proper Qlon for
<br /> ♦transport according to applicable Internatlonal and national, r ental tali
<br /> PdntedeT d Name �C '� C�/ -Signal u C� C' Date”.
<br /> 4.TRANSPORTER 1 ADORESS: Phone 8.
<br /> r•"
<br /> STF,Tt CYCX, plicable Permit umbers;
<br /> lVUzxte fiacxk
<br /> Ralnah.z Cordava,CA 515742 ID
<br /> Tl1f 14 'liY1sc>itgtl ?h lxutetik
<br /> TRANSPORTER CERTI iCAT N: Re, 1pt of medical waste as described abm.Sig
<br /> PrtnVlVpe Nama �' o '4" nature Date
<br /> bl-
<br /> 8.INTERMEDIATE HAN13LER 2/TRANS RTER 2 ADDRESS:
<br /> ACCOUNT 1: GM9077-002
<br /> 81011.odl 16mrlal Hospitil
<br /> INTERMEDIATE HANDLER/TRANSPORTER CERTIFICATION: Receipt of medical waste as described above. SERVICE DATE: 215110$;32:09 AR
<br /> DRIVER ID: ARI
<br /> Prinuiype Name . Signature 911PPIA TIMN tl14: gpgt;
<br /> 6.INTERMEDIATE HANDLER 31TRANSPORTI»R 3 ADDRE S:
<br /> t, TOTAL rAt.TTED: 2
<br /> IOTAL UKIIIiC•: 116.6W !}11'1'
<br /> INTERMEDIATE HANDLER/TRANSPORTER CeRTIFICATION; Receipt of medical waste as described above. :O KR6$ 0MM W
<br /> Print/type Mame Signalure
<br /> 7.DISCREPANCY INDICATION `AA4thRY(Cunl iym) 01V V
<br /> Trw to ` Nogh SO take,11 I(WA 13,41,1,xi Sllurin 4sm.; ? In eJr.
<br /> 8A.Designated Facility; 8B,Altemate Fa*litty: l -8C,Alternate Facility: MIN SWIMS:
<br /> STI~!~ICY'Ct.E.IINC, STERICYCLE.INC, g' MC1 CLE,INC.. TYPE UTI
<br /> t30 00010t L7rtv+la,Sub C 4135 W SvAAvtar�u SD North I-IQo1 t
<br /> Sart Leranft,CA WS77 Fre sno,',":A 33722 North StilttA-e.UT PAD64 Plb7 Pid:up 2 Gal NO$harps 1 00ru
<br /> (t 10)562- 176t (6559)279-099 (801)5a• Issas P(KI} Pidtip 3 Gal Dur%Vrps I.r1pp:
<br /> TS3I.'I"5/ItST25 TSMTS&E! EO p1Z C3mV lnch&m11on. UA Pidc,p 4 Gai Rio Sharps P,ll tolls
<br /> I•RATMENT FACILITY. I certify that I have been authorized 6y'the applicable state agency to accept untreate Df1lU�Lt: Ibrns,rdea, Atirarb
<br /> eoelved the above Indicated wastes In accordance with the requirement outlined in that authorization.` DfIlVE.�Y Weekly
<br /> NEXT 1`1110: 219110
<br /> 'rint/Typa Nemo I car��. �.... C11SIl1HER SIA ICc: (666)STERI-II:A1.
<br /> Thad ywi foi doosuy Stericycie
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