|
5tericycle• netuc, AL VVAZ$Lr e I HAt KINUi 1-u"" NUMtst:rt
<br /> I�C3g' p�SWF lMEpEj4CY'fCONTACTUqWM;QC�_1�p� ' jyjji'qG -10,06-STDgA[
<br /> •Qenator's Name Address and Telephone Number
<br /> A n+'1 tS1.
<br /> BIO�lat:DI MEMORIAt,
<br /> 975 SOUTH FAIRMONT DRIVE
<br /> t10i
<br /> (209) 334-3421 "�,'14/2010
<br /> CusrTOMER Numerut 6089077-002 GENERATOR'S REPESYAATM 0
<br /> 2A.DESCRIPTION OFWASTE 28. CONTAINERTYPE 2C, NO.OF 2D, VOLUME:
<br /> UN3291 RepulatedMAgl'oiil-Watd,3f>W XR65 - 1a.j.*Sgst:ft10: whnxps TZAA-- Ca3Ct (5V CU ft) CONTAIINNEAS
<br /> 6.2,Nil
<br /> UN3291,RoulaledMediceiwaste,,t.0.s., iKft13X - f•S.0,aigf•tt.=v Tranoport. Vox (4..3 au. ivy CuF
<br /> 3.2,poll
<br /> UN3291 Regulated Medical Wasto,n.o.s., Cu F.
<br /> l.z,f�i11
<br /> JN3291.Regulated Medical Waste,n.c.s., Cu F
<br /> 3.2,PGII
<br /> JN329f Regulated Medical Waste,n.0.&„ Cu>✓
<br /> 1.2,Poli
<br /> IN3291 Regulated Medical Weste,n.o.s., Cu F
<br /> 3,2,poll
<br /> 1N3291 Regulated Medical Waste,n.os., Cu F
<br /> i.2,-PGII
<br /> IN3291 RoDulaled MediW Waste,-nos.. Ca F
<br /> r.2,Poll
<br /> A]tJdT. Cu F
<br /> 3.Generator's Certification;9 hereby declare that the contents of hits cOnstgnmenl aro fully and accurately, TOTALS ► �2�A
<br /> described above by the proper shipping name,and are classified,packaged,marked and labelled/placarded,and Cu F
<br /> are in elf respects in props diitionn for
<br /> Iran ori a orcin oto ad Icable international and national gover ntal regulations, Q �}
<br /> PriniedfTyped Name 1.a�[�� + Clto"
<br /> 1.
<br /> �9 Signal ur JII�� J/ Date
<br /> I.TRANSPORTER f ADDRESS: Phone(IN N 9 85 - S ti 0 6
<br /> -717
<br /> 11075 14W.t a Rock: Rd � Applicable Permit Numbers:
<br /> 5'SERICYt"_C,T: `T`Hi� i a Thrt�uglt 3hi}�m�ttt,
<br /> 'RANSPORT> �' I� F�eee pt OfE edicat waste as described a
<br /> �n
<br /> Ani/Type Name Signature Date
<br /> INTERMEDIATE HANDLER 2/TRANSPORTER 2 ADDRESS: Phone N.
<br /> Applicable Permit Numbers:
<br /> VTERMEDIATE HANDLER/TRANSPORTER CERTIFICATION: Receipt of medical waste as described above.
<br /> rint/Type Name Signature Date
<br /> INTERMEDIATE HANDLER 3/TRANSPORTER 3 ADDRESS: Phone N:
<br /> • ftAiii� ._...
<br /> 4TERMEDIATE HANDLER/TRANSPORTER CERTIFICATION: Receipt of modleai waste as described above.
<br /> rintfrype Name Signature SkfiV147w,,
<br /> DISCREPANCY INDICATION ��jj Rfi11Pl
<br /> Transfe ed cs/y nontairner-5,fU3•(0 cu ft to : Not#h Salt lake, U1' (�i101i�Tl�: GM9077-002
<br /> Hospilal
<br /> aA.Designated Facility; U388.AlternateFacility I! I! SC,Alternate Facility: s9z� I:RvlR IO IL 5114110!1;19:41 AX
<br /> jM
<br /> STERICYCLF.INC. S T'Ef�IGYCLE,II C I r IO STERICYCi.> .Ii�l ' 9fIPP1ic DOCy kT
<br /> 1346 0001ittfe Diive. Suite C 4135 W.Savin Avenue AU(North 1100 West �WJO
<br /> {5 Oj eaandl 562- 1781 -04677 Fresno.CA 83722 North Salt Lake,UT 8405A TOTAL M-IiCTFR; 26
<br /> (510 T rn�T f 660)76 0994 {8151 A3r3- 1556 TOIAL tbltiii[: 222.4130 cU i'f
<br /> • Z, .• ILE ANNE taRTiz A&EyJOE P l
<br /> ALITOCI AVED PM 3 ,lrgidi KRV, 0000M
<br /> :r:S:zf(a Atrry� Kfi65 :a,F,ag;;aYLI
<br /> �EATMENT FACILITY: I certifythat I have been au(Karizec b Mite a 9cable state agency to accept unlreati , .440 WAM? RKBI "'
<br /> celved the above indicated wates In acoordance with tate requirement outlined in that-authorization:-- - Tsr W 1 Obi
<br /> iii 11 OOfiva MI
<br /> InVType Name ,r°,ichr.X'ffkiii tH)AO(JW R)BI
<br /> . tyi.Urn,i°I lj,� OOAli0U1 liX01 U+ilsi5'rk�I�llif
<br /> tK1At1DUY 0011t V4 RX8i
<br /> 0,11100d7 RX81
<br /> 5t1}i}fRliY{C,ml type}
<br /> l.lry
<br />
|