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®®® bier cycle --- q y CUSTOMER NO.211 C <br /> a holMNgPtogk Ned•.mgRnk Route N: 301 1 3 <br /> 1.Generator'sNam Address and Telephone Number <br /> ATTR: Brian Hanson 1 <br /> 3RI 5UMIGIAL <br /> 6901 LOU= ST <br /> STOCR'MI, CA 95206- 4907 9 14 :ply <br /> 203 482-5199 <br /> / <br /> CUSTOMER NUMBER — ••y GENERATOR'S REGISTRATION li <br /> CONTAINER TYPE 2C. NO.OF 2D. VOLUME <br /> 2A.DESCRIPTION OF WASTE 2B. CONTAINERS <br /> Cu <br /> UN3291,Regulated Medical Waste,n o s, 1.2- go-Gal Tub Biu 1.2 Cu 4t <br /> 6 2,PGII <br /> Cu <br /> UN3291,Regulated Medical Waste,n o S. <br /> 6 2,PGII T849 - 37 t;31 Tub (Bio) (4.9 Cu tt) / <br /> g ! <br /> UN3291.Regulated Medical Waste.n o s. ?Cu <br /> ® 62,PGI T014 - 44 Dai Tt3p(BiuD (S.s ru ft? <br /> I UN3291.Regulated Medical Waste,n os, TH121 _ 20 G.1 Tb(13i-) (2-7 Cu ft) <br /> Cu <br /> Q 62,PGII <br /> CC Cu <br /> W UN3291.Regulated Medical Waste,n o s T815 _ 20 Gal Tub (Path) (2-7 Cu rt) CutZ 6.2,PGII <br /> UN3291 Regulated Medical Waste,n o s. y1 <br /> 62 PGII T5 20 Gal Tt.tb (Cheat®) (2.7 ecu tt) <br /> Cu <br /> UN3291 Regulated Medical Waste.n o s, <br /> 6.2,PGII <br /> Cu <br /> UN3291,Regulated Medical Waste.n o s. <br /> 62,PGII <br /> Cu <br /> 17- <br /> 3.Generator's Certification:"I hereby declare that the contents of this consignment are fully and accurately <br /> =TOTALS <br /> described above by the proper shipping name,and are classified,packaged,marked and labelled/placarded,d/`acomental regulations <br /> X <br /> ll respects in proper condition for transport according to applicable international and natai.9®ve,� g <br /> v <br /> S re •��G�^ Date <br /> ted/Typed Name Pho e <br /> SPORTER t ADDRESS. /. (559)275-ng94 <br /> CC slteeigsytcl6,. Inc• This is a Through 911i�iBt1IL{PDhcabiePerm{tNumbers <br /> C 4135 V. Swift St g:;ul�r Reg3tE <br /> re a Fcesno,CA 93722 7 <br /> rn Z <br /> � Z TRANSPORTWANDLER <br /> F TION' ceipt meds waste as described abo L <br /> a a <br /> Date <br /> ~ Print/Type Name Signature <br /> Phone# <br /> 5.INTERMEDIAT2/TRANSPORTER 2 ADDRESS: Applicable Permit Numbers <br /> v <br /> L Q W <br /> L M!-, <br /> zDmo <br /> = INTERMEDIATE HANDLER/TRANSPORTER CERTIFICATION: Receipt of medical waste as described above <br /> Date <br /> =z PrmtlType,Name Signature <br /> Phone t♦ <br /> 6.INTERMEDIATE HANDLER 3/TRANSPORTER 3 ADDRESS: Applicable Permit Numbers <br /> L 4 W <br /> X Lu a INTERMEDIATE HANDLER/TRANSPORTER CERTIFICATION: Receipt of medical waste as described above ` <br /> t Date <br /> X: <br /> Signature <br /> s'`- Print/Type Name <br /> 7.DISCREPANCY INDICATION <br /> I7" CM Q tt01 <br /> s <br /> a ❑ 8D.Alternate Facility: <br /> 88.Alternate Facility: ❑BC.Alternate Facility: <br /> Designated Facility: ❑ Inc <br /> Inc 2775 .2891 St, <br /> J Inc. � i't� 30642 S8t Yerrtsn•CA 90068 <br /> q "s 4135 W. t St LIT94084 •CA (323)382- <br /> Fres,CA 93722 (5 10)%2-2 1 T7 (323136 26 <br /> a (Me)275-1121 (gal) T$91 23 <br /> TS108T22 <br /> a sthe <br /> ji <br /> TREATMENT FACILITY. <br /> end indicated wastes In accordance authorized <br /> h therequirement by <br /> �lloubl outlined that authorizations untreated medical wastes and that have — <br /> received thea Date <br /> Signature <br /> Print/Type Name <br /> LEAYE AT ENE TOR <br />