Laserfiche WebLink
619 <br />•teiriF CI@' IN CASE OF EMERGENCY CONTACT CH C 1.800.424.9300 <br />i�l v �. Route ft 024 - 7 CUSTOWR No. 21132 MDFROOGY30 <br />1. Generator's Naine, Address and Telephone Number I ` <br />WIDDEN LIVING HnAJIA - 569 <br />4645 SAELLEY CT <br />ST Ni CA 95207- 7232 <br />(209) 477-0271 9/23/2015 <br />OL. <br />Cu Ft <br />R" <br />1, <br />3, Gonerator's CerlMicatlon: 't hereby declare that the eonlent9 of this consignment are fu0y and a 6 TOTALS )0'. 1 <br />described above by the proper 0 ing name, and ata dasoad, packaged, marked and labs rd , and t <br />are Infill rtspwGs In propaP n fof tPansport togaepircada International and ria I Dvem tel <br />_ 0 tegidatiats' <br />Pdnledfi Name <br />4. TRANSPORTER 1 ff let Inc . This LLashi nt P <br />43.35 V. Swift AveuZerrmk 3400 <br />Fceano, Ch 93?i 2 <br />TRANSPO=CRTIFA71 �ecelpt of I waste as dl; <br />M"Ir ypeNeSignature <br />—GiEERDate <br />6- NTERMEDWtR 2 /TRANSPORTER 2 ADDRESS: Phoma fI: <br />Applicable Permit Numbers- <br />INTERMEDIATE HANDLER ! TRANSPORTER CERTIFICATION: R=1pt of medcal wade as described above. <br />Pdntfrype Name Signature <br />14-9 W. l b. <br />3 <br />Phone t <br />Applicable Permit Numbers• <br />INTERMEDIATE HANDLER / TRANSPORTER CERTIFICATION: Recelpt of medical waste as desated abom <br />PdnVPAU Name Signature O <br />aft <br />9. niAr!RFiMAtIW IAa4lnwren.r <br />v 6CywCte. Inc. cycle, Inc. <br />u 90 N oro Drive <br />t- Fresno.. '33722 AUxt1G vF North Sid . t1F 84064 <br />(016M 7422 UALE A.X"-L UKP 7�-7 22 <br />uj <br />lu <br />rS t115 <br />vial < <br />TREATM FAaLITY I certify that I have been aur prized by the at <br />N recehred the bone IrKlt d wastes !n accordance w the requireme <br />DemalRt...a Ala.® <br />w <br />W <br />Stericycle, Inc. <br />1661 Shelton Drive <br />Wittier. CA 96023 <br />(866)783.7422 <br />TWOS'T 83 <br />31140 N ?th S <br />3early <br />Karam CITY, ICS 66115 <br />(8$8)783-7422 <br />TWOST 28 <br />Usable state agency to accept untreated medical wastes and that I have <br />cutflned in that authorization. <br />Dale <br />cusTomNumaelt 6080856-001 <br />.ems oNA <br />2A. DESCRIPTION OF WASTE <br />20• CONTAINER TYPE 20. NO. OF <br />tet' ROPMW MOW fl4°^ <br />6a. <br />ARUM <br />Ta05 — 40 Gal Tub (Bio) (5.3 cu ft) COtYr <br />UNUIIt. M 7 .neo, <br />T849 — 37 Gal Tuts (sio) (4.9 au 11t)Fal <br />0 <br />0 <br />tNOfte,floi, <br />a$ Pcp <br />/ <br />Ta].4 - 4t Gal. Tub(Bio) (5.9 ou it) <br />t: ftplirl. it %a. no e. <br />To 2 1-' 7 arn--Ta Em0 a C <br />i(4. <br />&Z PON <br />111 <br />url M. rima. <br />82,Ptill <br />w83Z— (8 to) OJP31— (Path) WC31— (Chem®) 31 Ga Z4CUF <br />fjZt'UNM <br />a2 II iW8s0=&' <br />U043- tai.a) /PW43- (Path) /CW43- (Cbeao) Gal Tub (5.7cupT) <br />url72111,Rogule{ed Moft 4NiaJ�nos. <br />6.2. PGII <br />- Biosystems Cardboard aox (4.2 cu it) <br />OL. <br />Cu Ft <br />R" <br />1, <br />3, Gonerator's CerlMicatlon: 't hereby declare that the eonlent9 of this consignment are fu0y and a 6 TOTALS )0'. 1 <br />described above by the proper 0 ing name, and ata dasoad, packaged, marked and labs rd , and t <br />are Infill rtspwGs In propaP n fof tPansport togaepircada International and ria I Dvem tel <br />_ 0 tegidatiats' <br />Pdnledfi Name <br />4. TRANSPORTER 1 ff let Inc . This LLashi nt P <br />43.35 V. Swift AveuZerrmk 3400 <br />Fceano, Ch 93?i 2 <br />TRANSPO=CRTIFA71 �ecelpt of I waste as dl; <br />M"Ir ypeNeSignature <br />—GiEERDate <br />6- NTERMEDWtR 2 /TRANSPORTER 2 ADDRESS: Phoma fI: <br />Applicable Permit Numbers- <br />INTERMEDIATE HANDLER ! TRANSPORTER CERTIFICATION: R=1pt of medcal wade as described above. <br />Pdntfrype Name Signature <br />14-9 W. l b. <br />3 <br />Phone t <br />Applicable Permit Numbers• <br />INTERMEDIATE HANDLER / TRANSPORTER CERTIFICATION: Recelpt of medical waste as desated abom <br />PdnVPAU Name Signature O <br />aft <br />9. niAr!RFiMAtIW IAa4lnwren.r <br />v 6CywCte. Inc. cycle, Inc. <br />u 90 N oro Drive <br />t- Fresno.. '33722 AUxt1G vF North Sid . t1F 84064 <br />(016M 7422 UALE A.X"-L UKP 7�-7 22 <br />uj <br />lu <br />rS t115 <br />vial < <br />TREATM FAaLITY I certify that I have been aur prized by the at <br />N recehred the bone IrKlt d wastes !n accordance w the requireme <br />DemalRt...a Ala.® <br />w <br />W <br />Stericycle, Inc. <br />1661 Shelton Drive <br />Wittier. CA 96023 <br />(866)783.7422 <br />TWOS'T 83 <br />31140 N ?th S <br />3early <br />Karam CITY, ICS 66115 <br />(8$8)783-7422 <br />TWOST 28 <br />Usable state agency to accept untreated medical wastes and that I have <br />cutflned in that authorization. <br />Dale <br />