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Ove JterIC CIS® <br />boosue: <br />1. Generators Name, Address and Telephone Number <br />ATTR: <br />DEN .LIVING .HYPANA - 569 <br />4545 Sammy cT <br />STOMMUo CA 95207-- 7232 <br />MEDICAL WASTE TRACKING FORM NUMBER <br />IN CASE OF EMERGENCY CONTACT CHEMTREC 1-800 -424-9300 STANDARD MANFM 1101.10006-S1D <br />46e "A A CUSTOMER NO. 21132 ..�_®....� «-- <br />@I IIINB�A111196H1�11lIII IBI <br />D <br />3. Generatoes Certification: 9 heraby dectere that the contents of this coniagnitiant are fully and accurately TOTALS <br />atlove b tlla proper shippping name, and are classified, packaged, and p and <br />are In m respects k1 proper txutditlon for transpOtt eecord ng to applicable International and RW tions" <br />♦f �, s _ w. s -It 1 <br />SteciC:ycle, Inc. E3 This is a Thl:otugh Ship"rtt <br />4135 A. Swift Ave <br />Freeno,CA 93722 <br />C P1 of waste as descdb <br />Name S�R2a <br />2 <br />C. NO. OF 12D. VOLUME <br />CONTAINERS <br />Phone e: <br />Appltcoble Pem d Numbers <br />LATE HANDLER ITRANSPORTER CERTIFICATION: Recept of medical waste as described above <br />Fdnitiypo Name Signature Date <br />e. INTERMEDIATE HANDIER 3ITRANSPORiTER 3 ADDRESS. Phone q; <br />Applk" Pam* Numbers• <br />INTERMEDIATE HAND /TRANSPORTER CERTIFICATION: Receipt Of medcall waste as deacnbed above <br />PrinIf fte Name Strmature nmio <br />IIH <br />�� ANNE OR15 <br />i <br />I 'FACtLITY: I ceertiffy015 that I have <br />thw4bove Indicated wastes In aces <br />Name 0.& <br />ALS <br />V07 <br />a' <br />CusTotaea Nus M Coal M56--ow—at <br />Reatsmyloa A <br />.. <br />D.Aftensate Faculty. <br />2A. DESCRIPTION OFWASTE 29• <br />CONTAINER7YPE <br />9.2, 2li Regulated Medical Waste n o s <br />PA ted Medical Wisle n <br />62. P6l) <br />T049 — 37 Gas Tub Ria 4, 9 i t <br />®821 <br />fated W&% n o s„ <br />ll <br />Re <br />T814 — 44 Gx2 Tub Mio <br />UN3291 i ReguhtedMedical 1Naste,nos, <br />8.2, UPS', <br />T921� <br />—42XG)/TPIS—=Path)%TY15—tChm)20 Sal <br />Ic <br />IU <br />?� <br />BU.2,F61iR IW�tB,nos, <br />WB31-4Rio) /WP31—tPath 4KC31— ch a <br />$i1N299 liRegulated Medical Warts, no a <br />— <br />li ad"tia, <br />Ii.2, <br />— <br />D <br />3. Generatoes Certification: 9 heraby dectere that the contents of this coniagnitiant are fully and accurately TOTALS <br />atlove b tlla proper shippping name, and are classified, packaged, and p and <br />are In m respects k1 proper txutditlon for transpOtt eecord ng to applicable International and RW tions" <br />♦f �, s _ w. s -It 1 <br />SteciC:ycle, Inc. E3 This is a Thl:otugh Ship"rtt <br />4135 A. Swift Ave <br />Freeno,CA 93722 <br />C P1 of waste as descdb <br />Name S�R2a <br />2 <br />C. NO. OF 12D. VOLUME <br />CONTAINERS <br />Phone e: <br />Appltcoble Pem d Numbers <br />LATE HANDLER ITRANSPORTER CERTIFICATION: Recept of medical waste as described above <br />Fdnitiypo Name Signature Date <br />e. INTERMEDIATE HANDIER 3ITRANSPORiTER 3 ADDRESS. Phone q; <br />Applk" Pam* Numbers• <br />INTERMEDIATE HAND /TRANSPORTER CERTIFICATION: Receipt Of medcall waste as deacnbed above <br />PrinIf fte Name Strmature nmio <br />IIH <br />�� ANNE OR15 <br />i <br />I 'FACtLITY: I ceertiffy015 that I have <br />thw4bove Indicated wastes In aces <br />Name 0.& <br />ALS <br />V07 <br />a' <br />authorized by the applicable state agency to accept untreated medical wastes and that I have <br />a with the requirement outiirted in that authorization. <br />.. <br />D.Aftensate Faculty. <br />c - <br />3140 N 7th <br />c i ^ b <br />,e <br />authorized by the applicable state agency to accept untreated medical wastes and that I have <br />a with the requirement outiirted in that authorization. <br />