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4. TRANSPORTER I ADDRESS: Phone# (06 83-74579 <br />Stericyale, Inc. 0 This Through shipment <br />41.35 A. Swift Ave AppBea u Perrrat Nurndars <br />ireerno,CA 93722 Hauler Reg# 3400 <br />TRANSPORTS RTIFI TIO�tof waste as des atxsve. <br />PrinvTwe Name amnath. __ f n.ee 5�7~&� <br />2 /TRANSPORTER 2 ADDRESS. <br />ft-'' ' ' @'M - M I-. E i r-7 <br />Phone & <br />Appla:able Psmdt Numbers. <br />Date <br />ApPlIc" Pemut Numbers. <br />INTERMEDIATE HANDLER I TRANSPORTER CERTIFICATION: Receipt of medtcel waste as descnbed above. <br />Name Sloneh" M.I. <br />Transferred containers, _ eu E to : North Sag Lake, UT <br />M <br />ENI:FACILITY:1 certify that 1 have <br />theraboTAntVwastes in acco <br />ycle, Inc. <br />Sted ycle, Inc. <br />Stedcycle, Inc. <br />Foxboro ad" <br />1551 Shalton Drive <br />3140 N 71h Streottrfy <br />i® Steric �'Q` IN CASE OF EMERGENCY CONTACT. CHEMTREC 1.600-4249300 <br />41 <br />(WS)7W7422 ster� CA 023 <br />KS 1 s <br />" Route : 024 — B CUSTOMER NO. 11132 MDFROOGW7V <br />(860830. 4'22 <br />1. Generatol''s Name, Address and Telep one Number I <br />ATTN: I <br />I <br />TSIOST 83 <br />GOLDEN LIVING ANA -- 569 1 <br />4545 SSELLEY CT ` <br />STOCKWN, CA 95207- 7232 <br />(209) 477-0271 9/3/2015 <br />Cuetotten Nuum 6080856--001 GaNswann ReawmArcw# <br />2A. DESCRWnON OF WASTE 20. CONTAINER TYPE 2C. NO . -OF 7M. VOLUME <br />OF MI. Rodod Medol Wmdk wo K, CONTAINERS <br />TBOS 40 Sal Tub (Bio) (5.3 cu ft:) <br />PGO <br />Cu Ft <br />U1J3x94R4gadMedKal ,nos, TB49 _ 37' Gal Tub (Bio) (4.9 cu tt) <br />2, PGtI <br />6 <br />Cu Ft. <br />0UNW,Repulaled <br />MMIRGAotnos„ <br />6.2, PON TB14 » 44 Gal Tub (Bic) (S.9 cu ft) <br />Q <br />v <br />Cu Ft. <br />twat, Repwo Meftohkik n,oa- T821• (Bao) /TP15- (Path} TYCIS- (Chem*} 20 Gel Stub (2.7CUFT <br />'' PtiO <br />16N62. <br />Cu Ft <br />tu <br />1- h 31 <br />= p " M"ftw "O$- W821- (Bio} /gtp31- (Path) / (Cemo} Gal Tub (4.140 <br />) <br />Cu FL <br />POORagtdaled nut, y�43-1Bio) W43—(path)/Ctd43—(Chino) Gal Tub(S.70UFT) <br />s z, PGO t <br />LZpp0' Roosted °' °!° s- KR8 Biosystems Cardboard Box (4.2 Cu tt) <br />Cu F1. <br />1/N=, F.WhWdMadaalW9Znoi, <br />Cu Ft. <br />6.2, PON <br />Cu Ft <br />. M"dkal Vft t", nus., <br />62, PGG <br />Cu FL <br />I IA 3, tor's Ce►ttficadon: 'I hereby decfere thabthe contents of this con&vtmenl aro fully and accurately OTALS ® ` <br />Cu Ft <br />described by the proper shippingname, and qm classdled, packaged, marked and labelk placarded, and <br />alt acts In proper�condtbon far to appUcabla kltemedlonal and nation an-ragulaUaur: e <br />4. TRANSPORTER I ADDRESS: Phone# (06 83-74579 <br />Stericyale, Inc. 0 This Through shipment <br />41.35 A. Swift Ave AppBea u Perrrat Nurndars <br />ireerno,CA 93722 Hauler Reg# 3400 <br />TRANSPORTS RTIFI TIO�tof waste as des atxsve. <br />PrinvTwe Name amnath. __ f n.ee 5�7~&� <br />2 /TRANSPORTER 2 ADDRESS. <br />ft-'' ' ' @'M - M I-. E i r-7 <br />Phone & <br />Appla:able Psmdt Numbers. <br />Date <br />ApPlIc" Pemut Numbers. <br />INTERMEDIATE HANDLER I TRANSPORTER CERTIFICATION: Receipt of medtcel waste as descnbed above. <br />Name Sloneh" M.I. <br />Transferred containers, _ eu E to : North Sag Lake, UT <br />M <br />ENI:FACILITY:1 certify that 1 have <br />theraboTAntVwastes in acco <br />ycle, Inc. <br />Sted ycle, Inc. <br />Stedcycle, Inc. <br />Foxboro ad" <br />1551 Shalton Drive <br />3140 N 71h Streottrfy <br />837422 Lake. if T t340ti4 <br />(WS)7W7422 ster� CA 023 <br />KS 1 s <br />(860830. 4'22 <br />8,1A-36 <br />TSIOST 83 <br />TSIOST=26 <br />authorized by the applicable state agency to accept untreated medical wastes and that I have <br />e with the requirement outlined in that authorization. <br />"'� Date <br />