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sloes cation: I hereby declare that the contents of this ccrlslgnmemt are tidy and accurately TOTALS ® � <br />R above try the proper shipping rine, and are chased, Packaged, marked and tabapad/ I4 and s <br />mopeds kI proper coadedon for transport according to a s>Mmaho", d lassl er" ulatkuls' <br />Name/,/1, J" L sr` DataZy <br />All <br />2ral;rtaR t c%y�cle, Inc. This is a Through tenon. a 61a) 63- 2 <br />4135 V. Swift Ave Appicabte Permit Numbers <br />Fcenno,CA 93722 "Hauler P=0 3400 <br />IORTER C FIC ON pt of medical waste as described siboo. <br />2 ADDRESS: Ptx= Y <br />f` Apptuoabie Perot Numbers: <br />INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Recehx of mdkw valwaLAaw6rbed above. <br />Prlrsg"a Noma Signature Date <br />S. INTERMEDIATE HA 3ITRANSPORTER 3 ADORESS: Phone <br />Apptu�bte Pers d Numbers <br />INTERS__.. <br />1 <br />s <br />Pdnulwo <br />i DISCFJ <br />tu%NDLER ITRANSPOR I IERCERTIFICATION: Receipt of medical waste as described above. <br />Slpnaturo Date <br />Tfanwftnd cut it to: ftmsandlvd,UT <br />- 1 —.. , _s -. <br />- - - - . �. _-- <br />r1r <br />: <br />MEDICALWASTE TRACKING FORM NUMBER <br />® <br />®® � r'ic �! <br />O NCY . CHpNTREC 1.600•A249300 MA 001.1 <br />-CUSTOMER <br />• rn,11 <br />e NM 211`132 14DFMOGNSS <br />1. Generator's Namee,, Address and Telephone Number <br />GMDEN LIVING <br />SYPA - .569 <br />0tv. PM Sal 15 <br />.. - .. -7422 <br />4545 ==r CT <br />ST0017011, CA <br />95207- 7232 <br />1: <br />r '(209) 477-0271 1/8/2035 <br />Cummins Ntamen 6080856-001 GiviniRmwa REmsTwmtme <br />2A. DESCRIPTION OPWASTE <br />20. CONTAINERTYPE 2C. NO.OF 2D. VOLUME <br />waste, R.&&, <br />82 <br />5 — 40 Gal (Bio) (5.3 au tt) CONTAINERRS <br />PG11 <br />Cu PI <br />1iRe�llatedMadialwash,nos., <br />TBA9 - 3 Gal Tub o) (4.9 cu tt) <br />Ce,Fi <br />® <br />VMI , a oa . <br />T1314— 44 Gal o) (5.9 au tt) <br />2 PH <br />Cu >4 <br />Q <br />N3 I Rap01 Ided>catwasle, ".0j, <br />"I— emo <br />II <br />Cu Ft <br />2 <br />6$P IIR sdttbdeatWaste,sos, <br />-( a) I[P31-(Path!) tt1L'31-(tldato)31 Gal Tab(4.14 ) <br />Cu R <br />1jRepulated IWasta,n.o.s,, <br />�� <br />=43—(Bio)/PN43-(Path)jCRt43-(Chem*) sal 2vb(S.7CWT) <br />Cu Ft <br />a Nam 1t aa�taied Waste. s os., <br />®- Biosystems Cardboard sax (4.2 eu to <br />sloes cation: I hereby declare that the contents of this ccrlslgnmemt are tidy and accurately TOTALS ® � <br />R above try the proper shipping rine, and are chased, Packaged, marked and tabapad/ I4 and s <br />mopeds kI proper coadedon for transport according to a s>Mmaho", d lassl er" ulatkuls' <br />Name/,/1, J" L sr` DataZy <br />All <br />2ral;rtaR t c%y�cle, Inc. This is a Through tenon. a 61a) 63- 2 <br />4135 V. Swift Ave Appicabte Permit Numbers <br />Fcenno,CA 93722 "Hauler P=0 3400 <br />IORTER C FIC ON pt of medical waste as described siboo. <br />2 ADDRESS: Ptx= Y <br />f` Apptuoabie Perot Numbers: <br />INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Recehx of mdkw valwaLAaw6rbed above. <br />Prlrsg"a Noma Signature Date <br />S. INTERMEDIATE HA 3ITRANSPORTER 3 ADORESS: Phone <br />Apptu�bte Pers d Numbers <br />INTERS__.. <br />1 <br />s <br />Pdnulwo <br />i DISCFJ <br />tu%NDLER ITRANSPOR I IERCERTIFICATION: Receipt of medical waste as described above. <br />Slpnaturo Date <br />Tfanwftnd cut it to: ftmsandlvd,UT <br />C • •• . ��• •� ....� .. ......., a awu,w...cv wy — wvu m a,a1a aaaml..y Iv Q%ouapt u1RICa1au 111aulval waotab Ana alar F nave <br />received above Indicated was In accordan with the requirement oulbted in that authorization. <br />Printliype ms f'" • nature <br />�g Data <br />C <br />s <br />x 1 <br />ORIGINAL <br />a <br />r1r <br />SO Lffla.ur 840N <br />Hdk*w. CA <br />_ <br />0tv. PM Sal 15 <br />.. - .. -7422 <br />., 11-26 <br />1: <br />C • •• . ��• •� ....� .. ......., a awu,w...cv wy — wvu m a,a1a aaaml..y Iv Q%ouapt u1RICa1au 111aulval waotab Ana alar F nave <br />received above Indicated was In accordan with the requirement oulbted in that authorization. <br />Printliype ms f'" • nature <br />�g Data <br />C <br />s <br />x 1 <br />ORIGINAL <br />