Laserfiche WebLink
---- ------- <br />• MEDICAL WASTE TRACIGNQ FORM NUMBER <br />®;;®stel'1 cle' IN CASE OF EMERGENCY CONVACT: CNEMTREC t-ts�a2 EST�+, <br />• Route 0: 123 - 7 CUSTOMER NO. 21132 MDFROOJXON <br />Generator's Name, Address and Telephone Number <br />AWN-.0haron Miller <br />M413 -RAI -1. CAU S <br />2350 11 CALIrCRNIA ST <br />STOCRTOA, CA 95204- $506 <br />(209) 943-0854 11/21/2017 <br />3. Generatoft n: 9 hereW deciate that die contents <br />deaatbed abava (ty dla name, and �a <br />a p la �F i pile In proper f. t �i at <br />St:sciQlncZe, Ina. <br />4135 V. Swift Ave <br />Freano,CA 93722 <br />TRANSP RTT A tot a <br />pdnvrype Name <br />S INTEAPAEDIA7E HANDL 2 SPOtTrER 2 ADDRESS: <br />are fuAv and <br />i� �3 <br />Hauler Pao 3400 <br />EDIATE HANDLER /TRANSPORTER CERTIFICATION: Recato of medkA waste as desoribed above <br />Name Si Date <br />w aINTERMEDWrE HANDLER 3 /TRANSPORTER 3 ADDRESS: Phone t <br />Applicable Pamst NumbOM <br />INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Receipt of awdW waste as dosedbed above. <br />mov" Nam bhgnabae Date <br />F40 - ® as. <br />staricyde <br />inc, bw <br />4186 VY. . � >� N, tt:4ioro OtNe <br />t+- Preano,CA North Safi LSM, ()T 84054 <br />raw=a NOV 21 2017 (8"783-7422 <br />TREATMENT FACILITS4 at I have a by the appllC <br />- received the above tndlcaled in w41, the requirement a <br />PdnvpAm Nemo bee <br />f Tlanslis ed o <br />Hollister. CA am <br />TVO8T83 <br />abs agency to acxapt untreated medical wastes and that I have <br />t in that authort2atfon. <br />Data <br />out to <br />6018098-002 a <br />2A. DESCRIPTION OF WASTtt 2e. <br />CONI TYPE 2C. NO. OF 2D. <br />VOLUME <br />s td --a" <br />CONTAINERS <br />TBO5 - 40 G.1 Tub (Bi.) (5.3 Cu tt) <br />Cy FL <br />&Z std Medi ,na,s" <br />TB49 - 37 GTub (Bio) (4.9 Cu tt) <br />al <br />Cu Fa <br />p <br />Mp ft*WMe"-'s" <br />TB14 - 44 tial Tub (Bio) (5.9 Cu ft) <br />a.2, d <br />Cu Fc <br />= <br />W �i�u .i"— <br />TB21-(EDD)/TP15-(Path)/TY15-(Ch o)20 eal Tub(2.7t7=) <br />011 R <br />w <br />se$ <br />62 PE 1 <br />"n- i-(Bath)/W31-(Chemo)31 841 Tub(4.14CUPT <br />Cm R <br />tt2 PlN�R� Wask au& <br />l3-t8io}fpp�3-t�'eth?I�43-tChema} pal Tub(5.7CUP^T) <br />ta„ FL <br />a 2- tr i R"*W MMO Waft -'s-I <br />Mtn - Siosvetsms CardW&rd Box (4.2 cu ft) <br />_ _ Ou F,. <br />3. Generatoft n: 9 hereW deciate that die contents <br />deaatbed abava (ty dla name, and �a <br />a p la �F i pile In proper f. t �i at <br />St:sciQlncZe, Ina. <br />4135 V. Swift Ave <br />Freano,CA 93722 <br />TRANSP RTT A tot a <br />pdnvrype Name <br />S INTEAPAEDIA7E HANDL 2 SPOtTrER 2 ADDRESS: <br />are fuAv and <br />i� �3 <br />Hauler Pao 3400 <br />EDIATE HANDLER /TRANSPORTER CERTIFICATION: Recato of medkA waste as desoribed above <br />Name Si Date <br />w aINTERMEDWrE HANDLER 3 /TRANSPORTER 3 ADDRESS: Phone t <br />Applicable Pamst NumbOM <br />INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Receipt of awdW waste as dosedbed above. <br />mov" Nam bhgnabae Date <br />F40 - ® as. <br />staricyde <br />inc, bw <br />4186 VY. . � >� N, tt:4ioro OtNe <br />t+- Preano,CA North Safi LSM, ()T 84054 <br />raw=a NOV 21 2017 (8"783-7422 <br />TREATMENT FACILITS4 at I have a by the appllC <br />- received the above tndlcaled in w41, the requirement a <br />PdnvpAm Nemo bee <br />f Tlanslis ed o <br />Hollister. CA am <br />TVO8T83 <br />abs agency to acxapt untreated medical wastes and that I have <br />t in that authort2atfon. <br />Data <br />out to <br />