Laserfiche WebLink
tencycle' <br />ASE OF EMERGENCY CONTACT: CHEMTREC 1.800-424 <br />Rouge 0: Obi — 3 CUSTOMER NO. 21132 <br />MEDICAL. WASTE TRACKING FORM NUMBER <br />STANDARD MANIFEST 001 -10 -06 -STD <br />1. Generator's Name, Address and Telephone Number <br />( <br />ATTN a Lavonne Baldwin 1 <br />�� <br />A1=CA'N RED CROSS--STOC M'N <br />65 N COMMMCE ST <br />STOGKTON,, cA 95202-- 2318 <br />(209) 644--5131 <br />7/3/20.8 <br />CUSTOMER NUMBER 6146769_ GENERATOR'S REGISTRATION # <br />2A. DESCRIPTION OF WASTE <br />28. CONTAINER TYPE <br />2C. NO. OF <br />2D. VOLUME <br />UN3291 Regulated Melflcat Waste, n.o.s., <br />CONTAINERS <br />6.2. PGII <br />PBO4 — 28 Gal Tub(Bio) 3.7 cu ft) <br />Cu Ft. <br />UN3291 Regulated Modloal Waste, n.o.s , <br />6.2, PGi) <br />rB49 — 37 Gal Tub (Bio) (4.9 Cu t:t) <br />Cu Ft. <br />It <br />UNS291 Regulated Medfcaf Waste, a o S., <br />47-2 <br />0 <br />6.2. PGI <br />BIA: -- 44 Gal Tub (Bio) (5.9 cu ft) <br />Cu Ft. <br />d <br />IM <br />UN3291, Regulated Medical Waste, n o,s , <br />6.2, PGII <br />B21_ ¢ ) /TP15— /TY15— ( ) 20 dal Tt tb (2.7CUFT) <br />Cu Ft. <br />U.1 <br />UN3291 Regulated Megical Waste, n.o.s., <br />Z <br />6 2, PGII <br />Cu Ft. <br />LU <br />UN3291 Regulated Medical Waste, n.o.s., <br />6.2 ILII <br />3_ 43— e u 5. T <br />Cu Ft. <br />UN3291 Regulated Medlcal Waste, n.o s, <br />6.2, PGII <br />_ <br />Cu Ft <br />UN3291 Regulated Medical Waste, n,o.s., <br />6.2, Pull <br />Cu Ft. <br />UN3291 Regulated Medical Waste, n.os„ <br />6.2, PGII <br />Cu Ft. <br />3. Generator's Certification: "I hereby declar that the contents of this consignment are fully and accurately TOTALS l► <br />+7,,2 -Cu <br />Ft, <br />described above by the proper shi ing na nd are classified, packaged, marked and labelled/placarded, an <br />are In all respects In proper con i for t n o cording to applicable International and national governme a re alt <br />7 i Printed/ryped Name Signature <br />4. TRANSPORTER t ADDRESS: j <br />Date <br />Phor}g.,#SS783_7422 <br />D <br />w <br />Stericycler ino, This is a Throug 8hipm n <br />Applicable Permit Numbers: <br />a 0 <br />q o <br />4135 W. Swift: A Hauler Reg# 3400 <br />cn <br />FremnorCA 93722 <br />a� q <br />TRANSPORTER CERTIFICATION: Receipt of medical waste as described above. <br />a <br />Print/Type Name A?fii I/ r Signature <br />Date <br />5. INTERMEDIATE HANDLER 2 /TRANSPORTER 2 ADDRESS: <br />Phone #: <br />Applicable Permit Numbers: <br />A <br />INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Receipt of medical waste as described above. <br />PrinUfype Name Signature <br />Date <br />M <br />tc - <br />6. INTERMEDIATE HANDLER 3 /TRANSPORTER 3 ADDRESS: <br />Phone # <br />Applicable Permit Numbers <br />INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Receipt of medical waste as described above. <br />CnZ <br />� <br />F <br />Print/Type Name — Signature <br />Date <br />7. DISCREPANCY INDICATION <br />> <br />8A. Designated Facility: 813. Alternate Facility: BC. Alternate Facility: <br />SD. Altemate Facility: <br />=� <br />Sterlcycie, Inc. d cie, Inc. Stericycle, Inc. <br />Covanta Marlon,inc <br />4186 W. SWIft AVO 10 N, Foxboro Drive 1551 Shelton Drive <br />4860 Brooklake Road NE <br />f- <br />Fresno CA 93722 4otth Salt Lake, UT 84654 Hollister, CA 95023 <br />(866)763-7422 861}936-1171 <br />Brooks OR 97305 <br />(889)783-7422 <br />TWOST--22 E� A 448fJAr313 MOST -83 <br />(506)393-08911 <br />Permit# 364 <br />W <br />TREATMENT FAg1!LPa:QAr2' t I have been authorized by the appffcabfe state agency to accept untreated medfcaf wastes and that I have <br />received the above indicated was etes in accordance with the requirement outlined in that authorization. <br />PrInUI'ype Name _ Signature <br />Date <br />'Transferred containers, cit ftto <br />