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1 SterityCle' IN CASE OF EMERGENCY CONTACT;CHEMTIiEC 1.800-524-OW-
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<br /> (209) 334-"3411 5/28/2010
<br /> CU57OhiER NUr�e£n eiffNeWoli s REGISTnA-noN 0
<br /> 12A.DESCRIPTION OF WAST£ 213. CONTAINER TYPE 2C. NO OF 2p
<br /> UN3291 RCOLIbled Medleat Waste n.o.s., CONTAINERS VOLVW
<br /> 6.2,PGII DOT-Sp f ats Y.> �5 t3ir� yet�srx 5kulxpx Tr6TSC G11GL (59 ACt > C)
<br /> UN3291 Regulated ModkxI Waste,O.O.G., Cr
<br /> 6.2.1`1311 Byo�yntamc Tranvport Box (4.3 au ft)
<br /> UN3291,Regulated Medical Waste,n,o.s:, Cr
<br /> 6.2,PGI
<br /> UN3291,Regulated Me�lcat Waste,n.os., Ct
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<br /> US3291 Regulated Medical Waste,n.o.s., CL
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<br /> UN3291 Regulated Medfcaf Waste,n.o.s., Cr
<br /> 6.2,Poll
<br /> UN3291 Repulated Modlsat Waste,n.o,s., Ct
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<br /> UN3291 Regulated MQdGI Waste,n.o.s., Ct
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<br /> 3.Generator's Certification:"f herebherebydeclare that the contents Of this Consignment are fully and accurately TOTA�.S ► z` .
<br /> described above by the proper shipping name,and are Classified,paokaged,marked and labellodlptacarded,and
<br /> are In all respects In proper condition for transport according to applicable International and national govern al regulations"
<br /> Printed/Typed Nam -Au SlQnatura Date_W__'__
<br /> 4.TRANSPORTER 1 ADDRESS: Phone
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<br /> AppliCOb1 Pe ll[�fumbers: 5 O
<br /> 11875 Fh�a.te Hoak Rd
<br /> n'Y;1!'l YC1,E x a:s Through sha.pmr~nt
<br /> TRANSPORTERS .
<br /> F TM t lgVqftl waste as desodbod above.
<br /> Prtnt/Typa Name Sipnalura Dale
<br /> 5.INTERMEDIATE HANDLER 21 TRANSPORTER 2 ADDRESS: Phone ft;
<br /> Applicable Permil Numbers:
<br /> INTERMEDIATE HANDLER/TRANSPORTER CERTIFICATION:ReWIp1 of medicalwasle 86 desodbed above.
<br /> Print/type Name Signature
<br /> 6.INTERMEDIATE HANDLER 3/TRANSPORTER 3 ADDRESS:
<br /> �:Rulrt RE{:[IPI
<br /> INTERMEDIATE HANDLER/TRANSPORTER CERTIFICATION: Receipt of medical waste as describod above. 13Ip11.0(lir61mriid pilaf
<br /> ,avif: Ulf 512$!14 10:47;U2 rIH
<br /> Pr?nVrype Name Signature _ _ _ I)RltkR if): JW
<br /> 7.DISCREPANCY INDICATION
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<br /> Transferred OBJ containers, Ib0•V w ft to ; 11oft Salt lake, G f4TAl C01.1-ICTED: 27
<br /> ❑8A.Doslgnaled Facility; KWB.Alternate PacNny: _ 8C,Alternate FacsjuW to iE yr I4TAL UOLUHE: 226,$00 Eta F1
<br /> STERICYCtIw.INC. STIEFgICYCLE.INC. STERiCYCLE,INC. UWtWDU KR$5 ,4++Te:i r13rT1
<br /> u:fA{A>Of' 11031 4 IM,,RXBI f,:v"Al 18;111
<br /> 1345 Doolittle Drive.Suite C R 135 W. 5WA Avenue 90 North 1191]West WINNIW IMI 64AOMJ RXBI
<br /> San f_eandro.CA 94577 Fresno,CA 83722 North Salt take UT 84954 +uav,!A RXbI 0olto0tAt RXBI ,s,A:r(Yt Rio!
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<br /> TREATMENT FACILITY: I certify that I have been-authorizeut bY-the applicable state agency to accept untreat 11X81
<br /> ;. . R�(li t!t1AlxJI+1 RX81
<br /> received the above indicated wastes In accordance with the requirement outlined In that authorization.
<br /> PrWrype Name S na r ___ `.;iIHH,141Y(l;unt UCL
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