Laserfiche WebLink
410-:1106 stericycw <br />eewo�rm�: <br />MEDICAL WASCETRACIONQ FORM NUMBER <br />IN CASE OF EMERGENCY CONTACT: CHEMTREO 1-800.4241300 STANDARD MANIFEST 001- <br />P..+.0 Ar w2xi _ A CUSTOMER NO. 21132 2'an nnn_ <br />1. Generator's Name, Address and Telephone Number <br />i' ATTW: <br />rRADE11 M� .EiYPAIM — SGR <br />9545 SBEtLEY CT <br />S i 114 C 45207- 7232 <br />9 <br />�l <br />CUsmr+reaNu ftagg—nnit3EM <br />REOMtlretrogp <br />d ed abate by the r shipping dune, and ala clusthed, ed, marked and labelled/placarded, and <br />2A. DESCRUMON OP WASTE <br />21L <br />CONTAINERTYPE <br />2C. NO. OF 2D° <br />VOLUME <br />Medical Wade, n os, <br />adfryped Name nature <br />' <br />CONTAINERS <br />R'rER 1 ADDRESS" <br />Phone M: <br />(86E) 83-7422 <br />62%1Regulated <br />r <br />Steri' :l-01.13, Inc. Ttria i s a Ttzro t:,t em <br />— 4 dissv dS.3 ftt! <br />FI <br />Eaulet: Regrt 3400 <br />UI MI Regulated Medical Waste, nos., <br />02, PGIi i <br />TrA9 ^ 37 Gal Tcb (tie) (4.9 O12 %t) <br />ATIO cefpt of medical waste as dumbed above. <br />pa, TRANSPORTS) CERTI�F <br />Cu Ft <br />FF <br />1 lellWaNd Medical Waste, n 0 L, <br />02.poll <br />TS14 — 44 Gal TabMio) (S.9 CU '€t) <br />Data <br />• Gu FL <br />Q <br />iS132Mt Regulated Medical Wastd, n.os., <br />6zPGd <br />e — r — <br />? at8YC11jiP3r lr�atls��TYir �t It tt}:cti Gal TUb(2_7 <br />a <br />0 <br />INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: "asde <br />t0: <br />Receipt of inedicai <br />Cu Pi <br />UA <br />GA3�iRegula ,n.os„ <br />GANTERM IAM HANDLER 3/TRANSPORTER 3 A <br />��_1Ei��ft�+311-(leaar3bi/t�33-4C1a9)31 Ori Tubt4.34 <br />� <br />t7 <br />RM -1t ReOu tad odrgl wase n os , <br />INTER EDIATEHANDL.ER/TR P <br />ANS o CERTIFICATION: Receipt or medical waste as aescebed above <br />- a Name Signature <br />�l <br />r <br />ORIGINAL <br />3° Genetatces Certiflda llon:1 hereby declaw that the contents of this consignment era Itof and accurately TOTAL,$ <br />i Cu Ft. <br />d ed abate by the r shipping dune, and ala clusthed, ed, marked and labelled/placarded, and <br />all respects in proper conddron for transport according to applicable international nil governmental tegutattone" <br />li' , WPO <br />Ix,+ <br />adfryped Name nature <br />' <br />R'rER 1 ADDRESS" <br />Phone M: <br />(86E) 83-7422 <br />r <br />Steri' :l-01.13, Inc. Ttria i s a Ttzro t:,t em <br />Applicable Pelmet Numbers: <br />4135 M. Swift Ave <br />Eaulet: Regrt 3400 <br />ATIO cefpt of medical waste as dumbed above. <br />pa, TRANSPORTS) CERTI�F <br />Pnnvrfim Name nakrre. <br />Data <br />m <br />s. NOERMEDMA HANDLER 2 /TRANSPORTER 2 ADDRESS: <br />Phone N <br />Applicable Perm Nurnbem <br />0 <br />INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: "asde <br />Receipt of inedicai <br />PmWfypa Name Signature <br />Det® <br />GANTERM IAM HANDLER 3/TRANSPORTER 3 A <br />Phew p- <br />Applicable Parrott Nunnbers: <br />INTER EDIATEHANDL.ER/TR P <br />ANS o CERTIFICATION: Receipt or medical waste as aescebed above <br />- a Name Signature <br />Date <br />7. CY tND1CA7tON <br />77rwd- contains? , ext R to : North 89 Lake, UT <br />I—j <br />Dcstgnate9 Faeiluy 88 Aldernata PacgNy: eC Aitmato Feeiidy <br />8D. Aft—mate Faclaty: <br />e„ ln.. Sie&jT2&. Inc. stsricycle. Inc.. <br />sbsrY_ycle, Inc. <br />413 tih' -- ° s3 N. FftoW Dasa 15515t10%,n <br />C <br />Meet* <br />N 7th eet* <br />PEI;.-tb S&Lzk% UT E405- 05 4 HoNster, CA MW <br />ORTIZ <br />Kansas CRY, KS salts <br />tiz <br />) (OW)783-7422 ( s3-7422 <br />(866)783-7422 <br />2TE <br />r TaXIST 83 <br />°WOST=26 <br />2i0 14 <br />w <br />M <br />REATMENT FACILITY: that t Ye been authorized by the applicable state agency to accept untreated medical wastes and that I have <br />l— <br />nerved the above Indicated wash In a -cordance with the requirement oullined In that authorization. <br />N <br />Sie*rattuae <br />Dale -- <br />r <br />ORIGINAL <br />