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<br /> FroiWl,q hapkikdudnp Rk!' „eoe W .,VVo•tliU
<br /> Roux : gi. o aaa���9—edea MEIRC009 7RA,,.
<br /> !Z, Generator's Name,Address and Telephone Number
<br /> •.Y. ?LT7'H: Gay?e NF cs e a v �
<br /> B10l i3ODI ME1,'40RZAL WEST CAMPUS
<br /> 800 SOUTH L074ER SACRME NTT ROD
<br /> -
<br /> (209) 339 -1616-8 l�7l2Dio
<br /> CvsTumefi NUMBER 6089077-003 GFNERATOR'S RMSTRAMN p
<br /> 2A.DESCRIPTION OF WASTE 2B, CONTAINERTYPE
<br /> 20, NO.OF 2D. VOLUMa
<br /> UN3201 Regulated M �aI�` 1 , CONTAINERS
<br /> 6.2,M11 ul-� � "OS - 11310SYst:ebis 5t�,rgx Trn - Cart: (59 cu ft)
<br /> UN3291 Regulated Medica(Waste,n.o.e,, Cu 1
<br /> 6.2,PGII }{RBX - Bios;,st:ems Tranapart• Bor (4,3 au ft)
<br /> UN3291 Regulated Medical Waste,n.e.s., Cu I
<br /> 6.2,PGII
<br /> VN3291 Reoulated Medical Waste,n.o.s., ou I
<br /> 6.2,Poll
<br /> 03291 Regulated Medleal Waste,n.o,s., Cu'E
<br /> 6.2,PGII
<br /> UN3291,Regulated Medical Waste,n.o.s., "Cu 1
<br /> 6.2,PGII
<br /> UN3291 Regulated Medical Waste,n.o.s., Cu
<br /> 6.2,PGII
<br /> UN3291 Regulated Medical Waste,n.o.s., Cu I
<br /> 62,PGII
<br /> RS81
<br /> G
<br /> 3,Generator's Certification:"I hereby declare that the contents Of this consignment are fully and accurately �I OTAI.$ f
<br /> described above by the proper shipping name,and are classified,packaged,marked and labelfed/placarded,and Cu I
<br /> are In all respects in proper OYdition for transport Accor ing to applicable international and national governor tal regulations
<br /> Prinled(Typed Nam ! 0Signature Data
<br /> 4.TRANSPORTER 1 ADDR SS:
<br /> Phone6 16) gas 5506
<br /> r:
<br /> AppI1021e Permit Numbers; .
<br /> .1.Et375 White Raak pa
<br /> a'Y')vRl�l(t�LE ?'hi* i!� x, 'Mrotigh Shipment
<br /> i'RANSPORT13RYOrRT4I.=tfC T4QN &'pt of-W6i' 1 waste as described above,
<br /> >rintllype Nameti Signature Date
<br /> i.INTERMEDIATE HANDLER 21 TRANSPORTER 2 ADDRESS: Phone o;
<br /> Applicablo Permit Numbers:
<br /> NTERMEDIATE HANDLER/TRANSPORTER CERTIFICATION; Reoeipt of medical waste as described above,
<br /> 'dnVType Name Signature
<br /> i.INTERMEDIATE HANDLER 3/TRANSPORTER 3 ADDRESS:
<br /> SERVItE RECEIPT
<br /> NTERMEDIATE HANDIER/TRANSPORTER CERTIFICATION: Receipt of medical waste as described above, AClIMI I: 6089077-W3
<br /> D€01Lali Nrnor4l West CiMms
<br /> rtnt/lype Name Slgnaiuro S[R ;LT- DATF: 6111110 10:33;35 AN
<br /> DISCREPANCY INDICATION DRIVER IO: JDH
<br /> Transferred oontainers, _cu ft to : Notti7 Salt lake, U'T SHIPPffii DDGlR1K*'t: W0697ffA
<br /> 8A.Designated Facility. B8.Alternatf Facility: 6(:,Alternate Faclllty: TOTAL COLLECTED: 1
<br /> J�� TOTALVOLUHE; 4.300 CU FT
<br /> STERICYCLE.INC.”. 5rER M//CLE.INC. STI RICYCLC:,INC.
<br /> i�w nnnlittlp f'7rnvA �',i i0p C. 4186 W.Swift Avenge 90 North 1100 West 00=3 KROK
<br /> >>an I axnrfm :A 44.107 F'rs�.nn ('A 1.1' 77? North Sall:Lal*.UT 841164
<br /> 1510)692- 11113 l (6591275. 0904 (801)916- 1565 VOL
<br /> T'1 ( T:R(i"iSzi�!1 — 5A1� ._ .._.. . t�.P✓ .iN�11<, WMAIN(Cont Tyle) my Cl.,
<br /> �f�SIQS T"2'J.
<br /> &&S ANNE O�1Z
<br /> gU-ToC KRDI(fli6y�(ens transport Dox 1 1 ion
<br /> REATMENT FACILITY: I certify that I have been authorized by the applicable state agency to accept untreatec
<br /> 3celved the above indicated wastes In accordance with She requirement outlined in that authorization.
<br /> dnVrype Name Signature,,,,- CMIV€R: NIA Jason D.
<br /> -. TIfE011CId;Y; NrA
<br /> NEXT PICKUP: NIA
<br /> EUSTONFR tiFRVIC.: (Bfi6)STERI I:AII
<br /> Tlmi you foo dioasing Stericy%de
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