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p®: ® 5teritytle* ®® eer: I. - ,IF E MEDICAL WASTE TRACKING FORM NUMBER IN CASE OF EMERGENCY CONTACT. CHEMTREC 14=424-9300 STANDMO MANIFEST 001.10.05 -STD # : 024 - 10 CUSTOMER NM 21132 M'DFROOGCZ7 Generator's Nance, Address and Telephone Number RTT1d: GOLMN LIVING ImiVIA — 569 4545 SiMLLEY CT STOCMN, ,CA 951207— 7352 (209) 477-0271 4/2212015 CUSTOMEnNumeml 08 856-001 GENMTWS RFAWRATION�► ^ 2A. OE:SCRIPTION OF WASTE 2a. CONTAIVERTYPE 20. NO.OF 2D. 1IOttJME VN329tPGll INp10aled M8 de, Wa®.o s, 62. CONTAINERS T05- 40 Gats. Tab (Biel (S.3 an ft) S. INTERMEDIATE HANDLER 2 ITRANSPORTER 2 ADDRESS.Phone I: ry Cu UN328t ted Medcai Waste, n.e s , 6.2, 9 cu 9 - 37 real Tab Mei (4.�ft' INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Receipt at medial wase as described above. Cu FI 2 PGII Rail" Medkal WastA n e s, 6.% 7014 - 44 Gal TUIb(Vio) (S. 9 eU tt) r 5 Phare e: � t Cu Ft UNMI ted Medical Waft n ea, Gal Ttbtx.7CdFTB2,Pill INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Receipt of medical waste as described above u Ft. uAwl 62.PGIIfltsed 1-(13i,o)IWP31-(Patls)1=31-`CMM=031 Gal 9ub44.14C 3 Regldaled Medial Wnw, a as. 6z,PGlitM 43-tit►jlPftsl3-4Pat33j/43443-tie sm3 Tub(5.7CtIFT) Cu F1 UN320 91 Rephilad Medical Wt* n.es , = - ItLowlattems Cardboard sox (A.2 ca 'f t) I el.. c, 3. Generator's Certlficatfon. `i hereby dedere that the contonts of this consignment are key and accurately TC1TAi~S �" described above by the proper ahippklg name, and are classified, packaged, marked and 10belediphicarded, and are In all respects In proper cordhein for transport atx mit to applicable international and national governments!regu Prima d Name N C4a Jt� O IPAVretture 4.TRANSPORTER7 ADDRESS Stecicycle, Inc. Q This s:s a ormg Std1=e1M 4135 19. Swift ave rcesoo,pcA 93722 TRANSPORTER CERTIFICATION: Roolpt of rtmdeal waste as described above . L 0 Phone I: (966) 783=7422 Apphoeble Permit Numbers: Haatlec Tleo 3400 I = 10 06 z r L2 vtv Thanskmd-cauMnem.— C1,81LAttomete Fa®IINy: ytse. Inc. att�a 2' 1%. QSal.akle. Ur IE G: TIZ '8'M463.7422 APR 2 2 2014 KENT FACILITY I certify that t the //above Indicated wastes in 77 80. Alternate FacMty; shrlcyde. kr- 10-911 shabn OM HaMster. CA SM t86&)713-7422 83 $D. Altemato Facnity: Sbtirlt yde, k= 3140 N Tits streettify Xartaas CAV. KS MI 15 (SW783-7422 7S/OST-36 been authorized by the applicable state agency to accept untreated medical wastes and that I have dance with the requirement outlined In that authoraation. ^ 4124W pskanype Name mature pate S. INTERMEDIATE HANDLER 2 ITRANSPORTER 2 ADDRESS.Phone I: ry Applicable Permit Numbers - INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Receipt at medial wase as described above. PdaVlype Name S nature 19 Data n e. INTERMEDIATE FILER 3 / TRANSPORTER 3 ADDRESS, Phare e: Applicable Permit Numbers: INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Receipt of medical waste as described above PrErrt/rype Nam Signature pate I = 10 06 z r L2 vtv Thanskmd-cauMnem.— C1,81LAttomete Fa®IINy: ytse. Inc. att�a 2' 1%. QSal.akle. Ur IE G: TIZ '8'M463.7422 APR 2 2 2014 KENT FACILITY I certify that t the //above Indicated wastes in 77 80. Alternate FacMty; shrlcyde. kr- 10-911 shabn OM HaMster. CA SM t86&)713-7422 83 $D. Altemato Facnity: Sbtirlt yde, k= 3140 N Tits streettify Xartaas CAV. KS MI 15 (SW783-7422 7S/OST-36 been authorized by the applicable state agency to accept untreated medical wastes and that I have dance with the requirement outlined In that authoraation.