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ROUTE 1 <br /> Stericycle <br /> •. Regula9d Waste Shipping t3aen+ <br /> DOCUMENT NO -,,,7; ,,:��� <br /> f 1111 a�� � i� i� l <br /> ■ B I OT R A C KTM HAZaRUUUs MATERIAL SHIPP <br /> $ l - � Medical Waste Tracking System %xCUMFN I <br /> l i 11211 It a 1 W I i I g' i a 11 ? +l r i fit EMERGENCY PHONE: 18011-2 q 0; <br /> JI <br /> ACCOUNT #- 605947;-002 <br /> MANTECA CARE 8 REHAB <br /> z z ec,a CAA--e s Rehz-:y <br /> Name TRUICE DATE: 10111!04 01:51:i)o PM <br /> 1-7e< DRIVER 10 LHI <br /> Address <br /> A f1_, SHIPPING DOCUMENT q: MpFR001i3f1 <br /> City ] State - Zip <br /> f <br /> kEOUiATFO-4FOICAL WASTE 6 2,�fl,Ni�91. ;'IIT 1 <br /> Phone <br /> TOTAL COLLECTED: <br /> TOTAL VOLUME 5 4 CUBIC FEET <br /> CUUE iYPt: CODE TYPE "UVF <br /> TYNE <br /> AUTOCiLAVi BLE WASTE 10A00HJ T821 ooA00HM TD21 E, <br /> Cont Quantity Cont Quantity <br /> Type P/u Dei Type Plu Dei y THIS IS TO CERTIFY THAT THE <br /> MATERIALS ARE PROPERLY CLASSIFIED DE <br /> TB57 SH05 — -- 1, IN <br /> l' PAf.KADED, MARKED AND L HRFi I i -NO <br /> TB49 SH06 _ TE IN �1i0PFR CONOI TION FOR 1!rdN"i1'n{- IInN <br /> rt <br /> THE APPLICABLE REGUI.ATIONS OF <br /> TB35 SH07DEPARTMENT OF TRANSPORTATION. THE <br /> TB24 SH08 <br /> TB21 SH09 <br /> TB14,. SH11' PRINT NAME <br /> TB06 SH59 <br /> ST75 SH60 <br /> ST32f SH91 AUTHORIZED SIGNAil1RE.' <br /> _SH03 BX99 <br /> SH04 SH99 DEL I VERY DOCUMENT s <br /> ROFROO I i3F <br /> GENERATOR'CERTIFICATION:This is to certify that the above named'materials are properly,classified, dTOTAL DELIVERED ITEMS <br /> 2 in proper condition for <br /> transportation according;to the applicole regulations of the Department of Transportation. <br /> TYPE WTV TYPE UTY TYPE UTV <br /> , <br /> s r TB21 2 <br /> Print Name General i <br /> I <br /> NON-D.O.T. REGULATES' <br /> FG57 (33 <br /> XM99 RX03 l .X99 <br /> TD86 RX10 <br /> RX27 <br /> TRANSPORTER TRANSFER STATIONI <br /> Stericycle, Inc. []Stericycle,Inc. Q Stericycie; Inc. <br /> 28161 N.Keith Dr. 28161 N.Keith Dr. 11875 Whiterock Road <br /> Lake Forestel"I" <br /> IC 004x, yY Lake Forest,IL 60045 Rancho Cordova,CA 95742 <br /> (323)362 <br /> - ' (323)362-3000 (916)985-5506 <br /> Haz.Haut00 Haz.Hauler, Reg.#3400 MWTS Permit#34-6-P <br /> _ - - X X <br /> Authorized Signature 'Date Authorized Signature Date Initial Date deceived. <br /> AUTOCLAVABLEWASTE TREATMENT <br /> R'^ J IO WASTE <br /> DESTINATION7 <br /> Stericycle, !nc. Stericycle. Inc. I[[Stericycle,Inc. <br /> 4135 W.Swift Avenue "345 Doolittle Drive;Suite C 90 North 1100 West <br /> Fresno. CA 93722 San Leandro, -A 94577 // ' forth Salt Lake; JT 84054 <br /> 2275 X0992 5;Ol 336-9502 x 301; �6�1555 <br /> AWTF Permit#10-43-' MW TS Permit#19 28-P ` v'L�t ro- . !.�G�_ Iasfi / Incineration <br /> eatrgen'py_ utoclavang_. A'lVTF 'grmiz _ <br /> autho en ;..alar J.are <br /> 4_ - "ectr-.9 n�railOn <br />