Laserfiche WebLink
,LA UaLtIrrnit: derv-1I-LU11SPKI) 12:U5 P- 02406/17/2011 FRI 12: 21 FAX <br /> hooa Steric + RotN cMPRI�I� 0024/02 <br /> 8s utY01.10 -STD <br /> I.Generator's Name,Address and Telephone Number <br /> LODI MEMORIAL HOSPITAL <br /> 375 S FAIRMONT AVENUE <br /> LO€ I , CA 95240 <br /> (209) 335--7668 2/12/2010 <br /> CV5ffoM6*NL%MR <br /> GErrEW►TpR'S REa18TR0kr1pH <br /> 2A.DESCRIPTION OF WASTE 28, COKTAINER TYPE 2C. NO OF 2G. <br /> REGULATED(MEDICAL WASTE,n.o.s.,62 COkTAt ERS VOLUME <br /> UN 32$1.PG tI <br /> 3.11-(Plat-U) 44 Gal Tub (5.9 au E0 <br /> REGULATED MEDICAL WASTE. <br /> UN 3281.PG 11 T821-(Bio) / TB15-(Pat.h) J S-(Chemo 0 Gal Tub (2.7 <br /> f� REGULATED MEDICAL WASTE,n.0.8.,62, � Cu <br /> 0 UN 3291,Pta 11 T049-(Bio) / TE'49-(Path) J TY49-(Chelan) 37 Gal 'Cub (4.9 <br /> REGULATED[MEDICAL WASTE,n o.8.,6.2, Cu <br /> UN 3291,PS 11 98:15 - 26 tial Tub (Dio) (3.5 au ft) <br /> W REGULATED MEDICAL WASTE,p,0.s.,6.2, Cu <br /> uZ1 UN 3291,PG U T357 - 90 Gal Tub (Brio) (12 au ft) <br /> REGULATED(MEDICAL WASTE,nA.S.,6.2, Cra <br /> UN 3291,PG It 9864 - 48 Gal Tub (Bio) (6.4 cu ft) <br /> REGULATED MEDICAL WASTE,n.os.,6,2 Cu <br /> UN 3291,PG It _ <br /> 06 'Fish JBInI 01A <br /> REGULATED(MEDICAL WASTE,n_os.,6.2. LAr <br /> UN 3291,PG II 9764 - 64 Gal 'Cub (Bio) (9.67 cu ft) <br /> PtlaTmacemal Wase Cu <br /> CU <br /> 3 Generator's Cenlitration:`r hereby declare that the contents of this cpr slgnment are fully and amrately TOTALS 10- <br /> described above by the proper Shlppl+tg name,and are classified,packaged.marked and tabeiledlplacanied,and Cu <br /> are In a3 respects In proper condwon for&6Wtransports rding 10 applicable International and national govern ntal r Ialiona' <br /> tPriniadllypetlName 5 Data •l <br /> . 4.TRANSPORTER 1 ADDRESS: Phone#: <br /> 12�- <br /> App0.%,FQjRir nbers:3506 <br /> 11878 White Rock Rd Jn� <br /> i a S'1 CRICYCLE lX Thiv it a Through Shipment <br /> TRANSPORT a esuat sla as describod abm. <br /> PfinVType Nance Signature Date -`fx•jy <br /> S.INTERMEDIATE tIANDLER 2/TRANSPORTER 2 ADDRESS: Phona R: <br /> APPlicabta Permit Number <br /> INTERMEDIATE HANDLER/TRANSPORTER CERTIFICATION:Receipt of medical waste as described above. <br /> Printrrype Name Signature Data_ <br /> 6.INTERMEDIATE HANDLER 31 TRANSPORTER 3 ADDRESS: Phone M: - <br /> ¢ Applicable Permit Numbers; <br /> INTERMEDIATE HANDLEER/TRANSPORTER CERTIFICATION:Recelpl of medical veasla as described above. <br /> Pd VType Name Signature Date <br /> 7.DISCREPANCY INDICATION <br /> Transferred containers, CU it to : North Salt lake,UT <br /> taesla+reted Feclltry: <br /> W.Aftwnata Ferlityt 8C.Ahemats Far;mr. 80.Anamafe Fad! <br /> ar� <br /> STERICYCLE.INC. <br /> sTERICYCLE:.INC. STERICYCI.,I ,INC. SfERICYCLE,INC. <br /> 1345 Doorade Drive.Suite C 4135 W.Swh Avenue 80 North 1110 Wrest 1842 SI:w Dr <br /> San Leandro.CA 94577 Fresno.CA 93722 NoM Safi Lake,UT 84054 Yuba C y,CA 95991 <br /> j {510)502-1781 - 050.1275-0994 (8011938- 1555 a3() 790-0179 <br /> 7531.TWST26 TWOST 22 u;,! P-8.R-115 <br /> TRBATMEiNT FACILITY:I certify that I have been authorized by the applicable state agency to apt untreated medicalWRV�,tF�, <br /> received the above ind a n accordance with the requirement OuUine hat a ation. 1 t1 LU ave <br /> PrlrtUlype Nacos O E S Signature pate <br /> 000037 <br />