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00 Stericy fig � <br /> s. Re +d Waste Shipping Doftm� <br /> DOCUMENT NCj <br /> DATE:­ HAZARDOUS MATERIAL <br /> SHIPPING DOCUMENT <br /> BIOTRACK' Acca' y <br /> { ! ( <br /> Medical Waste Frocking system FMER6f:NC 1 PHONE ,800-234-OU51 <br /> P € j ? )3 <br /> ACCOUNT w, 6069471 11t12 <br /> MAN TEr. CARE ii REHAB <br /> DRI REGULATORY II. <br /> Name �x�_•���z ",arm <br /> �'��� ARf , SHIPPING DATE: 9,"N2004 11:09;24 AM <br /> DRIVER 10: THi <br /> '*.�._� .'-A,m..`et_:.sem_= z:Tis <br /> Address DER ;IIIPPING DOCUMENT a MDFR00IOZ1 <br /> Citi State Zip _ R1GULATEi1 4E01CAI 14ASTE <br /> Phone <br /> Emergency 6 2, UNs�91,PG1l <br /> �p1,1I COLIEC(FO ('ONfAINERS I <br /> 01 At VOLUME 5 9 CUHIC CF <br /> E.=a b a f:l UE YPE ,:JOE i Yf'F. :U1 L- <br /> 1 PE <br /> 'L'` iNAS Ia IOAR)AO TO14 <br /> Cont Quantity Cont Quantity d cont TH' IS f0 LR(ILY ;NAT THE <br /> Type PlU Det ape i/U Dei TyRa AHOVE NAMLU Mit,l t d 4,:, ARE PROPtRLY <br /> TB57 SH05 ?" T131 CLaSSIIIEO, OLSCRIHEII, PACKAGED <br /> MARKED AND LABELED, AND ARE IN PROPER <br /> TB49 ' SH06 » ° TY15 CONUIiION FOR TRANSPORTATION ACCORDING <br /> 10 IHE APPLICNBCE REGULATIONS OF HiE <br /> TB35. SH07' SH12 ; UEPAR'IMENI OF IRANSPORTAr1DN. <br /> TB24 SH08 SH14 <br /> TB21 SHG9 SH22 ' <br /> T1314SH11 F014 <br /> TBf 6. SH59 BC99 PRINT NAME <br /> ST75 SH6G BP99 <br /> ST32 SH91 SH24 <br /> SH03 . BX99 SG22 <br /> SH04 H99 SG50 7 AUTHORIZED SIGNATURE <br /> GENERATOR CERTIFICATION:This is to certifyr that the above-named materials are properly classified, described, packaged, marl <br /> transportation according to the applicable regulations of the Department of Transportation.: � <br /> x M <br /> Print Name' $. ' Generator's Signature Date <br /> NON-D.O.T. REGULATED WASTE <br /> FG57 RX1 G <br /> XM99 � RX27 <br /> TD86 RX99 <br /> RX33 <br /> A N7iiN�s j y - <br /> Q_.$tericycle, Inc. ❑'Stericycle,Inc. Q Stericycle, Inc;' <br /> ,�L8161 N.Keith Dr. 28161 N.Keith Dr:. 11875 Whiterock Road <br /> Lake Forest IL 60045 Lake Forest,IL 60045 Rancho Cordova,CA 95742 <br /> (323)362-3000`f (323)362-3000 (916)985-5506 <br /> Haz.F av1e17Reg.#W0 n Haz. r.Reg.,#3400 MWTS Permit 34-6-P <br /> NW <br /> X AF ' x X <br /> Authorized Signature Date AutTtonzed Signature Date Initial Date Received <br /> AUTOCLAVABLE WASTEi ASTE TRANSFEFf <br /> t � # <br /> Stericvcle Inc. Stericycle, Inc I F Stericycle, Inc: <br /> 13 5"vV. Swift Avenue ` 1345 Doolittle Drive. Suite C 90 North 1100'West <br /> rresno,CA 93-722 Can Leandro.CA 94577 North Salt Lake, UT 8405. <br /> 31 27P­')992 :0i 336-9502 '8011 ?36-1555 <br /> JAWTF 'Permit#10,-43-P AWTS Permit#19-23-P ;,ass incmerallon <br /> ,,aimenr auto saving_ fkVVTF 'ermat 37 18-P ° r arm 9 I <br /> 77-•_c �_cr� iUlhGrtZeC� lgnatLtf:� 'Q TS - �"ir ���" ,..'..�r3itrrl 1 <br /> a'E!IEt'ATVR "'P�! <br />