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nx uate/flme JUN-I1-Z011 (FRIJ 12:05 P. 018 <br /> 06/17/2011 FRI 12: 19 FAX 0018/028 <br /> '�•a 3al.+.dym+' Acu �Ocr Incr%,vnlw%o t <br /> ,.Generator's Net>„3,Address and Telephone Number III III III 11Ill1�1111111111111IN1111�1111i 11 <br /> ATT11f• r_�rl o Mnowv 1f <br /> "' ►`., " " <br /> °�'`' •." "' �111i4it111iitA1ii1 t�1i1�t <br /> BIOILODI MEMORIAL HOSPITAL <br /> 975 SOUTH FAIRMONT DRIVE <br /> LODI. CA 95240 <br /> (209) 334-3411 3/12/2010 <br /> Cufi'owl?NUMBER _0 0 2 GE"Oukrows REOrstRunorr <br /> 2A-DESCAFrION OF WASTE 29. CONTAINER TYPE 2C. NCL OF 2D. VOLUME <br /> REGULATED MEDICAE<0Ny:V?�,g SSS - Bias ::tams S CON7A1 ER8 <br /> UN 3281,PG 11 D T- 3„55ti 3saspz 'lrum Cart (59 cu ft) r <br /> REGULATED MEWCAL WASTE,n.o s,&2 Q <br /> UN 3291 PG 11 KR-BZ - Bi o3vatems Transport sox (4.3 Cu ft) <br /> m REGULATED MEDICAL,WASTE,n,t s,.62, Ct <br /> 0 UN 3291,PG It <br /> Q REGULATED MEDICAL WASTE,nAS.,6.2, Q <br /> UN 3291,PG 11 <br /> W REGULATED MEDICAL,WASTE,a.o.s.,6.2, G <br /> W UN 3291,PG If <br /> REGULATED MEDICAL WASTE,mO3.,62, G <br /> UN 3291,PG II <br /> REGULATED MEDICAL WASTE,n.1a.s.,L3.2, Ct <br /> UN 3291,P6 0 <br /> REGULATED MEDICAL WASTE.n.os.,6.2, Q <br /> UN 3291,PG Il <br /> CIL <br /> RHBI 7 <br /> 3.t3e11erators Certiticatlonr I hereby declare that the contents of this consignment are"and accuratelyTOTALS <br /> described above by IN Proper shipping name,and are cimirled,packaged,marked and a�elleWptacerded,and CL <br /> are in Isl1 respecle in proper itlon for transport accord' 10 aPPBca61e tnternationai and national govern nW regufaliorw I <br /> Prhtla ed Name Date ���t t <br /> - [.TRANSPORTER 1 ADDRESS: --- —� <br /> "IW16) 985 — 5.506 <br /> 1: 11875 White Rork Rd � Applicable Permit Numbers: <br /> ZTERICYCLE E� 1 This in a Through Shipment <br /> .2C TRANSPORTM&EHil UNIR( PI.modal waste as aescrbw above. <br /> ~ Print/Iype Name 77 SignaltirODate. f0'1+� <br /> S.INTERMEDIATE HANDLER 21 TRANSPORTER 2 ADDRESS: Phone•: <br /> i <br /> k ¢ APOcable Permit Numbers: <br /> INTERMEDIATE HANDLER/TRANSPORTER CERTIFICATION:Reeetpi of medical waste as descabed above. <br /> PdnN}ype Name Signature <br /> Dela <br /> S.INTERMEDIATE HANDLER 3/TRANSPORTER 3 ADDRESS: Phone e: <br /> ApptKable PernA Numbers: <br /> I� <br /> INTERMEDIATE HANDLER/TRANSPOR'T'ER CERTIFICATION:Receipt of medical waste as deeedbed above. <br /> ' Pr3nt/lype teams Signature Dale <br /> T.DISCREPANCY INDICATION 1 <br /> Trarlsfe d containers, s3'7 Cu It to : North Salt lake, UT <br /> • 6A.Designated PwIlity: 98 Alternate Facility. C.Altoffw to Facility: <br /> STERICYCLE.INC. STERICYCLE,INC. STERICYCLE,ING. STERICYCLE,INC. <br /> 1345 Doolittle Drive.Suite C 4135 W.Swift Avenue 90 North i 100 West 1812 Starr Dr <br /> San Leandro.CA 84577 Fresno.CA 93722 NDrth SaR Lake,LIT 840% Yuba City.CA 85991 <br /> j (5i01562-5761 '(5591275-0884 (901)936- 1555 (530)780-0170 <br /> Ts3A.TS(OST25 TSILJS'C 22 D L` 5Vvw,7"V <br /> t: <br /> TREATMENT FACILITY:I cerci at been authorized by the applicabt ager reated medical wast and that I have <br /> $ received the above Indicate aces rdanae with the requirement in <br /> i Prlrn,rype Name aI� �ALB ��'ERture :" I <br /> D81e `� 1. <br /> OQQ507v-�f <br />