|
06/1d'2005 13: 56 5592757409 SFI MEDICAL WASE PAGE 02/02
<br /> . �1'ICyCIe %
<br /> ,r Regu
<br /> d Waste
<br /> . tfiEAOOlI9AI li�j'� 'll��llllglllllp�Nj���f���l�� l; aMraAtFR!a
<br /> lpDkt wlkFo•me
<br /> aENT NO
<br /> DATE:7. �LKh;l. . I11(1W alu 14 uo'_,I
<br /> t
<br /> f1i
<br /> BIOTRACK kCCkmI •. b,,•,0X2
<br /> � F 1 "A_oicN Waata-Hacking$Ystam AW(�k1.rfCCA .';hl,irit
<br /> 4N'?f✓(;DO iPjdG iu 23.'9 AH
<br /> fHN<
<br /> Nacre M2nLt_ca Care S Rehab DRIVI
<br /> – ,ill1',!d R.N�UNfNI t IiC�'fit.>T719M
<br /> 410 E ~ ARRIN
<br /> Address �'_ '"��'� �►r�
<br /> City — ktante c� UEPA
<br /> -------- ��tat6CAjp—_953283567
<br /> Phone {'+s09) 235-1c22 �_ 111!:5 II�IFC,!; IGN,glM 1
<br /> Emergsncy a
<br /> iht I Vf; i it'll 1'lt LltUi. 171r
<br /> AUTOCLAVABLE WASTE NI, r ro clkl,F; :knl )p�
<br /> ContIN( !,o i'r A--0;,L;
<br /> Quentiry Cast Quantity .• v,un pk;- aid'U,
<br /> Type PIU Dei Type PIU Del Cont 4,,iXfil k..1)1 41'i 1 r p4!A11 N PttA'.M
<br /> T W—1 Type '; ItCi Ih, lulnd'41!."I;N Ll!!'i'INE
<br /> rSH)5 —1 �_ r , ,u, ;I:rr,l ;n ,:,,t',rls It 14.
<br /> TB49 �NH:?
<br /> i I - — I TB15 ��, ;;4r,1;�tratitlN
<br /> TY15
<br /> TB24 7 --•-
<br /> -.� I SHUe �
<br /> T'621 I SH14 I
<br /> r SHUg I , � —•-- _ f`----�". �F'Itil lc,�t:
<br /> TB14_' r SH11 S-- '2--?—!--
<br /> T206 SH59 ----- F014 I
<br /> ST75
<br /> �— SH60 - BC99
<br /> r"'-`-
<br /> ST32 --� — — BP99
<br /> SH03 I B 99 —i ! SH24 i
<br /> sH04
<br /> r SG22T
<br /> AERATI CERTIFICATION:This is to Certi that the ano,,@ narled materials are pT,Fegy Classified. jescxibed. paLiayaG�—ma�kg-L;,
<br /> nsportation accoronp m the applicable re ions of:he Department f Tra.^;portanCq
<br /> Print nme X
<br /> Generators Signature Dare
<br /> Lei 9 19r
<br /> FG57-r^�^ RX10 T-1
<br /> XM99 RI—X27 y -�r -I
<br /> rias I--
<br /> RX99 I
<br /> �RX33 T— �
<br /> 'Ttterloycle. Inc. Stericycle, Inc
<br /> ,28161 N Keith D ❑Sterlcycle, inc.
<br /> sake Forest 0045 28161 N.iCaitY,or. t 875 Whiterock 9uay
<br /> 1323) p Lake Forest. Il.60046 Rancno Cordova,G'A 911
<br /> Haz. uler.Re #3400 Haz42
<br /> 362-3000r. R (916)985.5506
<br /> Haz. Hauler. Req.x3400
<br /> tvrn/TS permit"3, 3 P
<br /> 1
<br /> -� Autr orizod Signatu d ~ Date i^� Authorizwd Signature Date x—'_;
<br /> i
<br /> tericycle, Inc. Stern'ufe In(;,
<br /> 135 W Switz Avence y '
<br /> 13.5 boc,lirtle Drive, Sesta�; _s .J«i_ 1 Z �['ala Stericycle, rnc,
<br /> -II CA 93722 San Loandro,CA ea577 i i 09 Norm t;00 Wetrt
<br /> 59)275-0992 $10 638-9502 'i North Salt
<br /> MTF Permit iii0-43-p I ) Lake,UT 84054
<br /> MWTS Permit st a-?3•P '.�Z^ tJEDICAL V�rA^I F I (BOt)9313-1565
<br /> ea t I' n VT' er 4 X-- } Class v Incineration
<br /> _ �p 3 �+ �tgFRf1t71I9P1 ,moo%iied Signature Date
<br /> Permit#91.02
<br /> TREATMENT FACILITY COPY 1 7•reatment by!nrincrat on
<br />
|