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terrcLe- IN CASs W: EMERGENCY CONTACT: CHEMTREC I -BW A24.9300 <br />,C� <br />r.Mttm�Nd: <br />CUSTOANM NO. 21132 <br />MEDICAL WASTETRACKING FORM NUMBS <br />STANDARD MANIFEST 001.10,MSM <br />1 1. Generator's Name, Address and Telephone Number <br />140 ATT14". 11 111111111111111111 <br />Cat,?WEN LIVING HYPAXh - bw <br />4545 =LLEY CT <br />I <br />wommul, CA 95207- 7232 <br />Cut:TOMER NUMBER <br />2A. oiscR1PTION ofwA <br />UN3291, R14tltated MAM Waste, ku <br />11.0 4 <br />GENm,mR's REGtsmnom r <br />-(Path)/TY.15-(Chem*)20 Sial Tub(2. <br />3. Genreatoele Certttication:' I hereby declare that the contents of this constpnnwd are fully erg aaxaarate[y L <br />des<xtbed above by lila ptaper Stkppitlg ngpne, esus ere tad, pec d, tnatic� and tataskedfpt�arded- and <br />ere to an �1 proper conddton for hansport acc m%V to hiternational and rtaMonai g t reputahons" <br />L <br />St:ericycle® Ino. <br />4135 1. SwLft; Ave <br />0 <br />SPQFrrER <br />4■ . • mac. <br />waste as <br />2C. Na OF <br />CONTAINERS <br />ww <br />Date <br />Phare M: <br />Applicable Permit Numbers <br />INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Receipt of medicalwasta as daubed above. <br />Ptiniffte Name stnnalwa not® <br />Hi <br />U 81 ANW4016 F*cW <br />SbericyCle. Inc. <br />9(40 Niettpl,� Lia tMj+ <br />Kanas w+Si Kg 66115 <br />I5 <br />( 1783-7422 <br />TSIOST-26 <br />medwal wastes and that I have <br />Ft. <br />skrmd Colftiaers <br />cu ik to _ North Sal lake, <br />ooatgaetod Facility: <br />U BCJUtemale Factnt . <br />u <br />lGAMITOCLAVE <br />kedcycle. Inc. <br />Sbukyde.Inc. <br />ua. <br />F45115YAMr= ORTIZ <br />N. Foxbtim <br />1561 Shaun Od" <br />Frese <br />orth S`allLake, lJl' 8AQ5-^ <br />Holllsbwr S <br />t <br />7sa-r a <br />x <br />F <br />T w Y? <br />