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— ..�U/ , 1MG du1r-1 r-LU11 irttl i IZ:U) P. 020 <br /> 06/17/2011 FRI 12: 20 FAX 2020/028 <br /> f r r• •�r�.nv <br /> Now♦r.•pc Vr Cn1CnVGryyr bVi�1K�r 1:4r•CMIrfCV Tai7i1'sJ•r•M+a -...w.,,v <br /> �+• ,•�►r• +"+ Route r : 413 •4 800-424-9300 MPR17008PBF <br /> I.Generator's Nettle,Address endTeleRhont3 Ntlsnber <br /> nTT�t: Gvle Maes <br /> BIO/LODI MEMORIAL HOSPITAL <br /> 975 SOUTH FAIRMONT DRIVE <br /> LODI. CA 95240 . <br /> 209 334-3411 2/26/2010 <br /> CuttT1)rIE14 Muraxl; .� GEliERAmR 8 RFTtutrloal A <br /> 2A•t]ESCFt1PT10 4 QF WASTE 2B. CONTAINER TYPE 2C.NO.OF 2D. VOWiBE <br /> REGULATED MEDICAL WASTE,n.a.s.,6.2, CONTAINERS •� <br /> UN 3291,PQ II DOT-SP 13555 IZR65 - BiaSystems Sharps Tr&= Cart (59 cm ft) <br /> REGULATED MEDICAL WASTE,n.o.s.,6.2, Ct <br /> LIN 3281,PG II <br /> AL WASTE.n.o „6.2, XRBX - Bi.osvtstems 'PI:Antport BOX (4.3 Cu ft) <br /> REGULATED MEDIC ,s Ct <br /> _ <br /> 111=== UN 3291.PG Il <br /> C REGULATED MEDICAL WASTE.a.a,s 8 2, Ct <br /> UN 3291,PG II <br /> UJ REGULATED MEDICAL WASTE,a.as.,6.2, Ci <br /> W UN 3291.PG It <br /> REGULATED MEDICAL WASTE,n,ab.,6.2, Ct <br /> UN 3291,PG It <br /> REGULATED MEDICAL WASTE,r+o.s.,6.2, Ci <br /> UN 8291,PG II <br /> REGULATED MEDICAL WASTE.n.a c.6.2. Ct <br /> UN 3291.PG It <br /> 3.Generatar'a Certinoation:I hereby declare that the contents of this consignment are luny and accurately TOTALS ► <br /> described'ab"by the proper shipping name,atld are classified,Packaged,marked and IadaHedlPtacarded,and <br /> are in an respects In proper condlllon for transport accting to appaoable International and nations[gore at regulations" <br /> i Prints Name Slgnatu -Date <br /> 4.TRANSPORTER 1 ADDRESS: PhonB p: g� �a <br /> _ 11875 Wlr;i>re Rork Ad Apr,(, le Fermi U51bera:5306 <br /> R B'3'ERICSfCLE © 'Phis is a Through Shipment <br /> E Cr TFtANSPORT%gr;FMFMAMYh�owosvKwwaMeesdftcrboOebm. <br /> PrfnV ype Name Signature Data •fib`/0 <br /> S.INTERMEDIATE HANDLER 2/TRANSPORTER 9 ADDREM. VPhone A: <br /> APplimble Penna Numbers: <br /> I INTERMEDIATE HANDLER[TRANSPORTER CERTIFICATION:Receipt of medical waste a$described above, <br /> PrinVType Name signature Dale <br /> B.INTERMEDIATE KWDLER 31 TRANSPORTER 3 ADDRESS: Ahong#_ <br /> Arpkable Permit Numbers: <br /> ;e INTERMEDIATE HANDLE#/TRANSPORTER CERTIFICATION:Receipt of medical waste as described above. <br /> ` PdWrype Name Wawa <br /> Hate <br /> T,DISCREPANCY INDICATION <br /> Transie ed, Containers, l�0 cu R to : North Salt Iake, UT <br /> - ❑ <br /> IIA.tloalgnowd Facility: G&Afremnta Facilitr", 8C.AtARM Fadalel'. / tu7.Arbrtrare Fadlity: <br /> 3fly// <br /> r ST�RiGYC iNC. gTl;_R C INC. IINC. CY .LNG, <br /> 1345 Doalittle f I�ve.SUite C Qi35 MWAvenue FARor#[i� West tarrZff <br /> San Leandro.CA 94577 Fresno.CA 03722 North Saft Lake,UT 84054 Yuba GiCA 95981 <br /> f5f0)587- 1781 1`559)275-0994W. <br /> TS?t.TS(QST25 TWST 22 (8f)1)938. 1555 (530)7$ 0170 <br /> Pit E <br /> T#IEATMENT FACILITY:I certity that I have been authorized by the applicab ate a O at:cept untreated medical waste a th <br /> received the above Ind In as O(ClOnce With the require in at l have <br /> PdA1/Type Name signature <br /> 000304 <br />