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3. Generators CoMficaUant'l hereby declare that the contents of this are fully and accurately TOTALS <br />d by the proper ahfppinQ name, and are clessilled, packaged, and ed, and <br />are bs ag in proper rax►dltton for transportaccordkrQ to applicable rntematlorat and national <br />St eei Ie, "Inc. ']!tr] g im a <br />4135 R. Swift Ave <br />Feesnu,CA 93722 <br />TRANSPOR'T'ERFICAI®ION: Receipt of medical waste as dascnbve. <br />ed abo <br />Privotm <br />Name 1/v Mn2Y sicnadxe - <br />ETYW; !Ii-;N:It#;1FK x11*1-}3 <br />/I <br />pale VQ IS <br />phones• (866 783-741'2 <br />Applicable Femur umbam <br />Battier: Regi t 34100 <br />INTERMEDIATE HANDLER !TRANSPORTER CERTIFICATION: Receipt of madxal waste as described above. <br />PnnLgwa None Signature pate <br />e. IN EDIATE HANDLER 3 / TRANSPORTER 3 ADDRESS, ph— tf: <br />Applicable Permit Numbam• <br />INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Receipt of Medical waste as described above. <br />Prmvlvm Name Skinaturo o,mrn <br />i) <br />l <br />3 <br />Vosm <br />MAY <br />Is 2015 <br />4bornate FaciOtyr. <br />authorized by the applicable state agency to accept untreated medical wastes and that 1 have <br />o with the requirement outlined in that atdhortzatlon. <br />�. <br />MEDICAL WASTE TRACKING FORM NUMBER <br />®• S1ericysle' <br />®•® <br />IN CASE OF EMERGENCY CONTACT: CHEMTREO 1.600.424.9300 MANWEESTODI-1e-MSTD <br />"0Rmte <br />f: 024 - 4 CUSTOMER NO. M 132 <br />1. Generator's Name, Address and Telephone Number <br />ATTN: <br />NG HS�AHA - 569 11 II11 II II <br />4545 MMUZET CP <br />SWCWTON, Ch 95207- 7232 <br />(209) 477-0271 5/6/2015 <br />cusmatmNuatesit 60$0856-00'1. GUERMORS 1`190151111CM 0 <br />2A.OESCRIFTIONOFWASTE <br />2B. <br />CONTAR�RTYi 2C, NO. OF 2D. VOLUME <br />.zPG11 Regulated Haddad Wade, t>A s <br />6 . <br />CONTAINERS <br />- 40 ftl Tub B;Vi0 (+-3 cu ftl Ft. <br />6Regutaed MedlcN Waste, ae s, <br />2, Ped <br />T849 - 37 csaL Tub (Biu) (4.9 cu tt) Cu Ft. <br />® <br />6U�*3p id Regulated M Waste. a o s.. <br />T01A - 44 Gal Tub (Bio) i5.9 cm tt? <br />bdMedimlWade,nes, <br />M2. <br />T221-t8S1S}lTP15-4P4th)J lS-ICbeme}20 sal Tub(2.7 <br />fr <br />FMM11 <br />6 <br />6�2,P�ciflt�idarod Wazte,rtos, <br />z-t8in}1c+1F31-(gatt!)lw�1-{a)31 ear 7uv(#.14 <br />} <br />UN329% Regidated Medcal Wada, Lei, <br />6.2,Psti <br />161111343-(si*)lwo3- qaLtN lCK1+3-tclaa eat Tttbt5.7c CuFL <br />UN3291 Rep , a es. <br />62. FOR <br />– ML2ffqte=2 +Catctibazzd Phot (4.2 cu >t C„ <br />UN32.91. Raeulated Medial Waste. n u.s.. <br />3. Generators CoMficaUant'l hereby declare that the contents of this are fully and accurately TOTALS <br />d by the proper ahfppinQ name, and are clessilled, packaged, and ed, and <br />are bs ag in proper rax►dltton for transportaccordkrQ to applicable rntematlorat and national <br />St eei Ie, "Inc. ']!tr] g im a <br />4135 R. Swift Ave <br />Feesnu,CA 93722 <br />TRANSPOR'T'ERFICAI®ION: Receipt of medical waste as dascnbve. <br />ed abo <br />Privotm <br />Name 1/v Mn2Y sicnadxe - <br />ETYW; !Ii-;N:It#;1FK x11*1-}3 <br />/I <br />pale VQ IS <br />phones• (866 783-741'2 <br />Applicable Femur umbam <br />Battier: Regi t 34100 <br />INTERMEDIATE HANDLER !TRANSPORTER CERTIFICATION: Receipt of madxal waste as described above. <br />PnnLgwa None Signature pate <br />e. IN EDIATE HANDLER 3 / TRANSPORTER 3 ADDRESS, ph— tf: <br />Applicable Permit Numbam• <br />INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Receipt of Medical waste as described above. <br />Prmvlvm Name Skinaturo o,mrn <br />i) <br />l <br />3 <br />Vosm <br />MAY <br />Is 2015 <br />4bornate FaciOtyr. <br />authorized by the applicable state agency to accept untreated medical wastes and that 1 have <br />o with the requirement outlined in that atdhortzatlon. <br />