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T. <br /> ROS <br /> 11 i� Stericycle Regulald Wastehi ireAme <br /> ff 111�nn II ii ,,uu'' I HAZARDOU; HATER I AL <br /> {�I I�1� 1�I�11111 SN I FP I Nli DULUM�N i <br /> DOCUMENT NO - DATE: <br /> s, = »� ' TRACK EMERGiACY PHONE jot) 234 Until <br /> s t f a Medical waste 7Yacking system ACCOALI'UNT a bo5yn 71 101 � v4i'[CA LAH, , HEHAI! <br /> itFGULATUHY q, <br /> t ; <br /> DRn OHIPP!% DATE "I12I2004 12:03:04 PM <br /> » V ^z etak= DRIVER IU: THl <br /> Name AR <br /> Address ,_ . _ DEPT 'HIPPING UO[uMENi x MDFR0n1M6P <br /> ry Rt51bA;fn MiJI(:mi WASFE <br /> �� ) 5.2, UN32Yi PG 11 <br /> City �.: . : _� State Zip _..: <br /> Emergency <br /> Phone fUlAl Cpl EFI!r UN'INERS :0 <br /> nMAI 001!,01 , [:F <br /> 71g <br /> A 7 0C AV_ BLE Tl AS'i' ' PRINI ,LAME <br /> Cont Quantity Cont Quantity Cont { <br /> Type- P/U Del Type P/U Def Type <br /> TB57 5 TB1`5 <br /> TB49 SH06 TY'1'5 <br /> AUTHOR!?ED IGNATURF <br /> TB35 SH07 SH1`2 <br /> TB24 SH08 SH14 ' <br /> TB21 SH09 SH22 <br /> TB14 SH11 F014 3 <br /> TB06 SH59 BC99 <br /> ST75SH60 BP99 <br /> ST32 i .. <br /> SH91.,. SH24 <br /> SI—H03 BX99 SG22 <br /> { <br /> SH04 SH99 SG50 <br /> GENERATOR CERTIFICATION: This is to certify that the above-named materials are properly classified, described, packaged,marked and labeled, and are in proper condition.for <br /> transportation according to the applicable regulations of the.Department of Transportation. <br /> Print Name Generator's Signature Date <br /> NON-D.O.T. REGULATEDWAS"ArE <br /> FG57 RX10 i <br /> I <br /> XM99 RX27 <br /> TD86 RX99 <br /> RX33TRANSPORTER TRANSFER STATION <br /> i <br /> ss <br /> a 1 <br /> 5tericycle, Inc. ❑Stericycle, Inc. []Stericycle, Inc. <br /> 28161 N.Keith Dr. 28161 N.Keith Dr. 11875 Whiterock Road <br /> Lake Forest, IL 60046 take Forest,IL 60045 Rancho Cordova;CA 95742 <br /> (323)362-3004-` (323)362-3000 (916)'985-5506 <br /> Ha?,.Hauler.Reg.#3400 Haz.Hauler.Reg.93400 , MWTS Permit#34-6-P i <br /> X _ X � X <br /> Authorized Signature. Date Authorized Signature Date. ! Initial Date Received <br /> t <br /> Stericycle, inc. <br /> Stericycle, !nc. S tericyc+e Inc. — ;. <br /> +135 W.Swift Avenue 1345 Doolittle Drive, Suite C 90 North 1100 West <br /> -esno. CA 9372_ San Leandro, 3A 945'? -lorth Salt Lake. UT 340541 <br /> 5-59)275-0992 1510) 336-9502 30 <br /> . :,ass a n�ineratian; 1 <br /> AWTF�erm,j f i-? ��.4WTS Permit +19-23-P <br /> reatmen , r ,JWTF`' t 3c48:P ermi � � r _ .r( 2 <br /> c.,Gv n . <br /> . ^ a <br /> tn� ,...it 1(�„fl.?U:fP _.,.. .._ <br />