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MEDICALWASTETRACKING FORM NUMBER <br />�!} SterlcyCle' IN CASE OF EMERGENCY CONTACT: CHEMTREC 140&4244= STANDAM MANWM oo,.iaa-SM <br />a.u�oMa•�e Rout® #,. 123 - 8 CUSTOMER NO. 21132 <br />1. Generator's Name, Address and Telephone Number <br />ATTN:Sharon MillerI�'�1 II <br />F(4C-RAI-31. CALZFCRXA-STOCWMN <br />2350 R CALZFORMA ST <br />STOCKTO)t, CA 95204- 5506 <br />(209) 943-0854 11/28/2017 <br />50 11011 11111`11111511 <br />110 <br />I Milli <br />■Thi3 in a Through shipment <br />4135 V. Swift Ave <br />• M <br />.: <br />/TRANSPORTERRTJJKTRTI CP wasmw as <br />INTERMEDIATE HANDLER <br />PdroFTI,a <br />,, <br />C. NO. OF Ito. VOLUME <br />CONTAINERSWAXER <br />�arri� <br />Date <br />6. INTERMEDIATE HANDLER 3 f TRANSPORTER 3 ADDRESS: Pro" IF. <br />Applicable Pemin NutM em - <br />MEDIATE HANDLER /TRANSPORTER CERTMATION: Roceo of moftal wam as dwated abase. <br />Name Signature Date <br />■ .:T. Jltwnaft Feeley: JL r;."r.- <br />Sbwkyde, Inc. <br />a «, oftro s • <br />rIve <br />Fruna.CAS37NoM Set <br />LaW. UT „.HoWdor. CA :•W.:rt : �.°.1Y� <br />[k r. ..r Y + :rtr <br />w� <br />TSK)= TW=83 <br />{ e .t <br />z <br />i <br />TrardfOred waakws, cu2to, <br />00@179 <br />ORIGINAL <br />•MN <br />6018098-002 <br />2A. DESCmPnoN OF WASTE 2e• <br />CONTABiER TYPE <br />61 nal RegoleW Iu�tal Wase, nes. <br />TBOg - 40 Gal Tub (Bio) (5.3 cu ft) <br />WOtg1, Waft <br />82, Pali <br />T949 - 37 Gal Tub (Bio) (4.9 Cu It) <br />C <br />86.2.PGIIUNMu�pl n.as., <br />T914 - 44 Gal Tub(Bio) (5•9 Cu tt) <br />)"1. <br />n.os., ^_TB21-(BXO)/TP15-4Path}/TriS-(Chem6)20 <br />9a1 Tub43.7CUP <br />Wt, <br />W <br />Regi Waste, n.o e., <br />8.2 i4iil <br />III (Biot /MP31- (Path) /VC31- (Chemo) 31 Gal Tub (4.14CtJ <br />62 PGII Reguleed M Waste,no.s. <br />MB43-(Bio)/PM43-(Path)/Cu43-(Chemo) Gal Tub(5.7CUFT) <br />a2 iii nay' <br />IAB - Biosystems Cardboard Boz A4.2 cu ft) <br />50 11011 11111`11111511 <br />110 <br />I Milli <br />■Thi3 in a Through shipment <br />4135 V. Swift Ave <br />• M <br />.: <br />/TRANSPORTERRTJJKTRTI CP wasmw as <br />INTERMEDIATE HANDLER <br />PdroFTI,a <br />,, <br />C. NO. OF Ito. VOLUME <br />CONTAINERSWAXER <br />�arri� <br />Date <br />6. INTERMEDIATE HANDLER 3 f TRANSPORTER 3 ADDRESS: Pro" IF. <br />Applicable Pemin NutM em - <br />MEDIATE HANDLER /TRANSPORTER CERTMATION: Roceo of moftal wam as dwated abase. <br />Name Signature Date <br />■ .:T. Jltwnaft Feeley: JL r;."r.- <br />Sbwkyde, Inc. <br />a «, oftro s • <br />rIve <br />Fruna.CAS37NoM Set <br />LaW. UT „.HoWdor. CA :•W.:rt : �.°.1Y� <br />[k r. ..r Y + :rtr <br />w� <br />TSK)= TW=83 <br />{ e .t <br />z <br />i <br />TrardfOred waakws, cu2to, <br />00@179 <br />ORIGINAL <br />•MN <br />