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0-04.016 001® Stertcycle' <br />® <br />1. Generator's Name, Address and Telephom <br />I ATTN. <br />IN CASE OF EMERGENCY C . <br />ROU #: 184 7 <br />GOLDEN ZrWNG RVANA – 569 <br />4545 SRELLEY CT <br />STWMN, CA 95207- 7232 <br />pq <br />tv J <br />MEWCALWASTETRACKING FORM NUMBER <br />,C 1-1100-424A300 STAMWD MMtIFM OM -10 *FrD <br />4MERND.z1132 14DFROOG977 <br />Number `- <br />477-0271 <br />3. 's CerttNgtion: "I h meby declare that the contents ol this consignment are hdly and z5curalely T®TAS$ <br />described above by the proper sldppmg neM and are ctassdmd, pedapd, marked and tabe2ed1placarded, and <br />are In all respects m proper condition for t b hematatnaf and national governmental regrdatioss.' <br />Nil w_ji <br />3/25/2015 <br />ALWHESS: Phone 1. t <br />St@ci 1e, Inc. This is a Through shipment (866) 783-742e <br />St:er c le, t`.t Ave us Im �m* Numbers: <br />Baulet: Reg# 3400 <br />rcesnoeCA 93722 <br />ICE FICATION: Recelptof Medical waste as described above, <br />Data <br />[ANDLER 2 ITRANSPORFIER 2 ADDRESS: Phone is <br />Appikable Permit Numbers: <br />INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Receipt of medical waste as described above <br />PdnHlvpo Name slarratura Date <br />IL INTERMEDIATE HANDLER–3 -/TRANSPORTER. 3 ADDRESS: Phone M: <br />Applicable Permit Numbers- <br />In <br />INTERMEDIATE HANDLER /TRANSPORTERCERTIFICATION: Receipt of medical waste as described above, <br />PnntrlWm Name Slonalumo — Data <br />CW MERNUM80 6090 56-001 GErENAYoW8REpWRan09e <br />2A. DESCRIFT10N OF WASTE <br />• CONTAINERTYPE 2C. HO OF <br />umt liepulated Ma ul Waste, nes, <br />8.2,PSII I <br />CONTAINERS <br />1H05 - 40 Gal Tub (Bia) (S.3 on ft) ' <br />1� RepUlated Medica! Waste, a e a , <br />T849 - 37 Gall Tub (Biu) (4.9 cu tt) <br />IC <br />"d Repleled Waste, t,,u. <br />T8 - 94 Gal Tub (f lic) (5.9 cu tt) <br />C <br />1d Flegaleted Medical Warta, n.cs, <br />Tg21- (8I0) /TPJ.5- (Pa tb) /TY15- (Chemo) 20 tial Tub (2.7MMT) <br />e. Inc. <br />Stedcycte. Inc. <br />a:1vv9TdWdw <br />UJ <br />Z <br />WOW Regulated Medlcai Waste, n o s„ <br />e2, Psil <br />W831- (Bio) /WP31- (Pahl) /t+tC31- (Chemo) 31 gal Tab (4.14CUFT <br />3140 N 7th StiasttTly <br />gU PtdA�ulated lWaste,me- <br />ErtB63-(Sio)/PWG3-tPath)/CW43-(Chemo) -gal Tub(S.7CUFT) ~ <br />o , UT 8405--05-4 <br />UN381 Regulaled Medical <br />U. poll�Wbw° <br />US _ - Bios3rstetas Cacdboard Bax (4.2 cu tt) <br />3. 's CerttNgtion: "I h meby declare that the contents ol this consignment are hdly and z5curalely T®TAS$ <br />described above by the proper sldppmg neM and are ctassdmd, pedapd, marked and tabe2ed1placarded, and <br />are In all respects m proper condition for t b hematatnaf and national governmental regrdatioss.' <br />Nil w_ji <br />3/25/2015 <br />ALWHESS: Phone 1. t <br />St@ci 1e, Inc. This is a Through shipment (866) 783-742e <br />St:er c le, t`.t Ave us Im �m* Numbers: <br />Baulet: Reg# 3400 <br />rcesnoeCA 93722 <br />ICE FICATION: Recelptof Medical waste as described above, <br />Data <br />[ANDLER 2 ITRANSPORFIER 2 ADDRESS: Phone is <br />Appikable Permit Numbers: <br />INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Receipt of medical waste as described above <br />PdnHlvpo Name slarratura Date <br />IL INTERMEDIATE HANDLER–3 -/TRANSPORTER. 3 ADDRESS: Phone M: <br />Applicable Permit Numbers- <br />In <br />INTERMEDIATE HANDLER /TRANSPORTERCERTIFICATION: Receipt of medical waste as described above, <br />PnntrlWm Name Slonalumo — Data <br />ti G" t <br />h <br />O <br />O <br />t' ORIGINAL <br />7. DISCR NCY tt�ICAiaN <br />Tmnsferred containers, <br />cu A to : North W Lake, UT <br />Daatpraded Fecliity: <br />WAX Fedfity: <br />U &C. Attemate FacURr. <br />aD. Anonuto-FadGty: <br />Stedwde. k1C. <br />Stedcycle. Inc. <br />e. Inc. <br />Stedcycte. Inc. <br />a:1vv9TdWdw <br />• <br />90 N. Falftiv DrWe <br />1551 Shetbn Drive <br />3140 N 7th StiasttTly <br />Fo.CA+ <br />iCLAVE <br />o , UT 8405--05-4 <br />Hollister. CA as= <br />Kansas City, M Wits <br />ZANNE <br />ORTIZ <br />(8 6)763-7422 <br />(8"783.7422 <br />t TM7422 <br />a <br />36 <br />TWOST83 <br />TWOST--26 <br />7' Cf�il r�+� shatIhav hasnauthonzedbythea a slate agency to accept untreated medical wastes and that I have <br />t– <br />above Indicated wastes In -a <br />ante With the reciurrement outlined in that authorization. <br />ti G" t <br />h <br />O <br />O <br />t' ORIGINAL <br />