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L CUSTOMER NO.21132 lg101:f:�lt:S];;'7i,� <br /> ®• MUlmin9 People -9 Red. Bul' ROut.e 6: <br /> 1.Generator's Name,Address and Telephone Number. <br /> A't1TN:Rrian Mangan <br /> J <br /> 37ti stsfe+sarzai� <br /> 6801 LONGE ST" <br /> S'TfrXTC121, t o 95zi)6- 4907 2i112 <br /> (24►9� 482-5199 11!4 <br /> CUSTOMER NUMBERC.�,0 ... 0'1 GENEnATows REGISTRATION# <br /> 60"LCONTAINER TYPE 2C. NO.OF 20. VOLUME <br /> 2A.DESCRIPTION OF WASTE 20• CONTAINERS <br /> UN3291,Regulated Medical Waste.n o s, TB1t} Cut <br /> 6 2,PGII TEIOS _ 4t? Gal Tub (�i.o} (S-3 <br /> UN3291.Regulated Medical Waste,n o s, T849 — 27 Gal TUb ( cl) (4-9 Cu ft) Cul <br /> 62,PGII f' <br /> CC UN3291.Regulated Medical Waste n o s TB14 •- 44 (3311 Tub d Oia) (5,9 Ou 1Et} Cu I <br /> 0 6 2.PGII <br /> (' UN3291 Regulated Medical Waste,n o s, T921 _ 20 tial Tub(Bio) (2-7 c:u ft) Cut <br /> Q 6 2,PGII <br /> Ir Cu f <br /> W UN3291.Regulated Medical Waste.n o s, ,$815 20 Gal TUb (Path) (?•7 r,u ft) <br /> Z 62,PGll <br /> NJ UN3291,Regulated Medical Waste,n o 1, Cul <br /> 0 62,PGII TY15 — ) ;;ad T41b tGhetBan) {2.7 cu ft} <br /> UN3291,Regulated Medical Waste,n o s Cut <br /> 62 PGII <br /> UN3291,Regulated Medical Waste,n o s, <br /> Cut <br /> 62.PGII <br /> Cul <br /> 3.Generator's Certification:"I hereby declare that the contents of this consignment are fully and accurately <br /> TOTALS ► `� . �` cut <br /> described above by the proper shipping name,and are classified,packaged,marked and labelled/placarded,and <br /> are in all respects in proper condition for transport according to applicable international and national governmental regulations" <br /> Date <br /> rintedlfyped Name Signature <br /> P ... <br /> Phones {rtcjca�77,1 ll�i <br /> 4.TRANSPORTER1ADDRESS <br /> CC This is ThCp h ShiPIDenAppilcablePer <br /> mtNumbers <br /> wSteeicr:;1e, Inc. 11autiet Rego 3401.1 <br /> 4135 Si. Swift St <br /> NFvesnt:r,CA 937222 <br /> a a TRANSPORTER CERTIFICATION: Receipt of medical waste as described above <br /> Date <br /> t 7"A Signature Print/Type Name Phone b <br /> 5.INTERMEDIATE HANDLER 2/TRANSPORTER 2 ADDRESS 'f J ! Applicable Permit Numbers <br /> LQ2 >f <br /> —8 W <br /> W <br /> K W z INTERMEDIATE HANDLER/TRANSPORTER CERTIFICATION: Receipt of medical waste as described above <br /> r Date <br /> _� Printnype Name Signature <br /> Phone tt <br /> uw 6.INTERMEDIATE HANDLER 3/TRANSPORTER 3 ADDRESS Applicable Permit Numbers <br /> XQ6 <br /> =W J <br /> n s c INTERMEDIATE HANDLER(TRANSPORTER CERTIFICATION: Receipt of medical waste as described above <br /> 0 -Date <br /> z Print/Type Name Signature -- <br /> 7.DISCREPANCY INDICATION tU{b 16 : ftah Lake,UT <br /> — <br /> 4' 8C.Alternate Facility: aD Alternate Facility: <br /> �. 3 r 6A.Designated Faclliry: 85.Alternate Facility: <br /> r+'I"�pflCyChA,IRC <br /> — ,I 27 75 E 2M St <br /> 1 S�wicycle, n <br /> Sp f 90Q ,CA 94'544 Ern��n,CA 90052 <br /> 4135 Vd(.S�tlflt Sit No (3231362-3000 <br /> a m1. Fres�'tc+.CA 93'722 .UT <br /> (610)562-2177 <br /> $ (SS9j 275-t 121 ��t� 36 Twi i' xxM6 TSJcyST 26 <br /> LU TSMT22 <br /> 3A.44to� eRceived the abo et and sated wasteSiI have been authorized by the n accordance with the requiremenpitoubinedan thaeauthorization. <br /> pt untreated medreai wastes and that 1 have <br /> ►" <br /> Date <br /> o <br /> Print/Type Name Signature <br /> LEAVEAT GENERATOR <br />