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To: Page 44 of 45 2016-09-12 13:06:14 CDT 18776791797 From:Customer Care <br /> Stericyclew IRCASE OF EMERGENCY CONTACT' CHEMTREC 1.800 830 <br /> P-LMIMP"fif 9M&RAW CUSTOMER NO.21132 <br /> Route #: 122 14 MDFROOH4FK <br /> 1.Generator's Name,Address and Telephone Number ff <br /> ATTN:Dave Kowalczyk <br /> QUEST 13TAGTIOSTICS <br /> 2291 9 MARCH LN BLDG r <br /> STOCKTOW, CA 95207- 6652 <br /> (209) 961-5031 11/9/2015 <br /> C115MMERNUMUR 601 R 8 -b02 GeNetAToies RileisTmmou 0 <br /> 2A.DESCRIPTION OF WASTE 20. CONTAINER TYPE 2C.NO.OF 20. VOLUME <br /> 1114201.Regulated Me"Us%moxCONTAINERS <br /> 6.2,PGII TBOS 40 Gal Tub (Bio} (5.3 cu ft) Cu Ft. <br /> 1.11,1329i.1egulated Merkel Vh*.n4-s„ <br /> &Z PS)l TB19 37 Gal M (Bio) (4.9 CU tt) Cu Ft <br /> 1.1100i,6.2,PGII Ragulaind Medics!Waste,rms., <br /> "3 TB14 44 Gal Tub(Bio} (5.0 Cu tt) Cu Ft <br /> hr UN3291,Regulated Medical Viade,nu.. (vat:h)/TY15-(Chem*)20 Gal Tub(2.?CUPT) <br /> 62,Pelt Cu R. <br /> UNWI,—Rwhlad Medical waste,au., <br /> 6 2.PGII Gal Tub(4.14CUP9) Cu Ft. <br /> 11,11,13201,Raoulated Medical Wasis,n.o.s., <br /> 8.2,PGII Qat Tub(5.7CUFT) Cu FL <br /> Mail,ftowstall MO&W waiii,mos., <br /> 0.2.PGII Biosystems Cardboard Box (4.2 cu. ft) Cu Ft <br /> UNZ191,A"Waled Medical Wage,nos.. <br /> 6.2.Poll Cu Ft. <br /> UNW,Requialod Medical Wesw,mos., <br /> &Z PGII Cu Ft. <br /> ttfication, I hereby declare that the cortlents,of this consignment are fully ON accurately ITOTALS Cu Ft, <br /> -C� proper aw*01-W <br /> 3-"tor"' 2 <br /> dt -- p Or Ing name.and am classified,packaged,marked and W <br /> Dil _Per dl It for transport according to applicable Internaffonal and=10 men <br /> 61t,X.—.-.- ft-M.--b gulation <br /> drry <br /> d dirrypedName-aig- <br /> Cm 4Z;A <br /> -a. SP6RTER I ADDRESS; PhdKeP (966)783-7422 <br /> Steck ycle, Inc. Q This is a Through shipmen-t Applicable Permit Numbers: <br /> 4136 9. Swift Ave <br /> 0Hauler Reg# 3400 <br /> IL rresno,CA 93722 <br /> W <br /> It TRANSPORTERTIFICATlQN;J%cOIptof;pqdIcaI waste as desert dab <br /> PrInuryps Name=71--j Signature Date <br /> 'S.INTERMEDIATE HANDLER 21 TRANSPORTER 2 ADDRESS- Phone <br /> Applicable Permit Numbers. <br /> INTERMEDIATE HANDLER I TRANSPORTER CERTIFICATION:Receipt of medical waste as described above, <br /> PrInVType Nam Signature Date <br /> U,INTERMEDIATE HANDLER 3/TRANSPORTER 3 ADDRESS: Phone <br /> I ., <br /> Q. <br /> Applicable Permit Numbers <br /> Q. INTERMEDIATE HANDLER I TRANSPORTER CERTIFICATION:Receipt of medical waste as described above. <br /> PdnVlVpo Noma Signature Data <br /> 7.DISCREPANCY INDICATION <br /> Transferred containers,-CU ft to ' North SON Lake,UT <br /> Ogg 80.Altemeta Facility; &c.Astemate Facility: So.Alternate FacIlilly: <br /> le, SterIcycle,Inc. Stericycle,Inc. stericycle.Inc. <br /> N.Fodlioro Wire 1551 Shelton DM 3140 IN 7th Stmattrfy <br /> LL; FresnoCAMMCLAVE IN Sat Lake,UT 84054 Hollister,CA 95023 KAnsas M KS SiSi I$ <br /> Ste <br /> a <br /> CAD I nawd ForA <br /> N 8'Inc.I <br /> F k MR <br /> eqno-C <br /> (bass) 0"VANNE ORTIZ (8 6)783-7422 (866)78a-7422 (CGG)703-7422 <br /> 2 <br /> TSIOST22 TS/OSTW TWOST-26 <br /> N10V 09 2015 <br /> TR ENT FACILITY:I certify that I have On authorized by the appliciable state agency to accept untreated InOi(Ilcal wastes and that I have <br /> above <br /> recal ad the above Indicated wastes In acco once with the requirement outlined In that authorization. <br /> AI& <br /> Priv po Nama.-aue Signature two <br /> ORrGINAL TRACIONG DOCUMENT <br />