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Phone N. - <br />Appli-We Pam* Numbers - <br />INTERMEDIATE HANDLER I TRANSPORTER CERTIFICATION: Receipt of medscal waste as described above. <br />Pdnilrype Name Stgnatum Date <br />S. INTERMEDIATE HANDLER 31 TRANSPORTER 3ADDRESS: _ ._ ---- III. <br />Applicable Pemltt Numbers: <br />INTERMEDIATE HANDLER I TRANSPORTER CERTIFICATION:'Raeelpt of medcall waste as descobed above. <br />PainIf ype Nome Signature Dab <br />en n to : Nodh Sak Lft, Lff <br />s®®®® sterl dw IN CASE OF EMERGENCY CONTACT, CHE C 1.810-6MSOD <br />` Routs #: 024 - 3 CUSTOMER NO. 21132 MDFROQGSFZ <br />SwrIcycle, Inc. <br />1. Generator's Name, Address and Telephone Number <br />1663 DNS <br />ATTN: I III milli I win 111111 <br />8140 N 71h srestirry <br />GOLM LIVING H7P -- 569 <br />NO11101er, G <br />4545 MIELLEy cT <br />to soils <br />`7422 <br />STOCKTON, CA 95207- 7232 <br />( 783-7422 <br />• (209) 477-0271 8/12/2015 <br />( <br />CuaTONERNumseR SO MAOGENERATOR'S REGISIRATIOND <br />79A=83 <br />2A. DESCRIPTION OF WASTE 213. CONTAINER TYPE 20. NO- OF 2D. VOLUME <br />-26 <br />tursisa. Wwstae nam. CONTAINERS <br />state agency to accept untreated medical wastes and that I have <br />e Pall TBGS — 40 Gal Tub (Bio) 15.2 .au ft) C, Ft <br />in that authorization. <br />Medrdwasta na%. <br />tl TE49 - 37 Gal Tub (Bio) (4.9 Cu tt) <br />PrdCUR <br />UNMI, RegWaled. <br />82. Pok TUG - 44 Gal (Bio) (5.9 Cu tt) Cr! Ft <br />W"te' T821- (Bso)1721S- (Path) / - (Chom*) 20 Gal Tub (2.7C ) <br />a Pon � Cu R. <br />zez <br />Phil dated mss, 111831- (BiWUP31- (Path) /K=1l (Chemo) 31 Gal (4.14C ) OU FL <br />L9 <br />a m—T tTagrda� NWCW westa, "a,, <br />az PGA 4 42- (ai o) /1 ASI- (Pat h) /CXA3- (Chemo) Gal Tub (S. 7CMFj) Cu FI <br />UN3Ze1, ModkalMO. oos.. <br />GZPGN 111.14118- Bio Car rd Box (4.2 au ft) Cu Ft <br />UMI. R.0100 Xdkalore.. <br />862. PAN a✓e�ahff&M) c CUR. <br />UN3nI,RaPh ted Madkal Waste, a o.e, <br />62. PGR CU FL <br />3. Genoratar'a tion: I hereby dedam that the contents of this conakgnment are My and acarrately TOTALS <br />Cu F' <br />=lab <br />described above try the d11 ping name, and we dassIlled, packaged, marked d <br />In <br />are all Maps jin proper n for transport according to I1 We International and N bis <br />Priv Name 3 Habra per. <br />4. TRANSPORTER1 ADDRESS; Phone 1h <br />, , (866)783-7422 <br />Pei <br />Stericyale, Inc. This a a Thrortgh obi nmesrrt Applimbre PermR Numbers - <br />4135 W. Swift Ave <br />Hauler Reg# 3400 <br />Freeno,CA 93722 <br />A <br />Ea <br />TRNSPORERFICAI er ,Taste desa&V. <br />Phone N. - <br />Appli-We Pam* Numbers - <br />INTERMEDIATE HANDLER I TRANSPORTER CERTIFICATION: Receipt of medscal waste as described above. <br />Pdnilrype Name Stgnatum Date <br />S. INTERMEDIATE HANDLER 31 TRANSPORTER 3ADDRESS: _ ._ ---- III. <br />Applicable Pemltt Numbers: <br />INTERMEDIATE HANDLER I TRANSPORTER CERTIFICATION:'Raeelpt of medcall waste as descobed above. <br />PainIf ype Nome Signature Dab <br />en n to : Nodh Sak Lft, Lff <br />. Inc. <br />01ton <br />SwrIcycle, Inc. <br />1663 DNS <br />8140 N 71h srestirry <br />NO11101er, G <br />to soils <br />`7422 <br />( 783-7422 <br />( <br />79A=83 <br />-26 <br />Icable <br />state agency to accept untreated medical wastes and that I have <br />outlined <br />in that authorization. <br />Date <br />