Laserfiche WebLink
h! � ® <br /> Ow �3 - CUSTOMER N0.2113 <br /> 1.Generator's tame,Address and Telephone NUmbeP <br /> Aj"rN:8xian Hanson 1!t1 ti <br /> MU SURGICIAL <br /> 6801 LONGE ST <br /> S7 CrM,", L"l. 95206- 4907 <br /> (209) 982-5199 tri"11: �;11 <br /> GENERATOR'S REGISTRATION N <br /> CUSTOMER NUMBER601(j095-002 2C. NO.OF 20, VOLUME <br /> 2A.DESCRIPTION OF WASTE <br /> 28 CONTAINER TYPE CONTAINERS <br /> UN3291,Regulated Medical Waste,n.o s.. TR0 S - 40 Gail Ttilb (viot (5.3 °'tz ft) Cu Ft <br /> 6 2,PGII <br /> UN3291,Regulated Medical Waste,n.o s.. T4349 - 37 Gal �.� (81•r1i t,4.9 �bs ft) Cu Ft <br /> 62,PGII <br /> Cr UN3291,Regulated Medical Waste,n.os, TU14 - 44 GAI Tw1b(Diol (5-9 C%A f Li Cu Ft <br /> 0 6.2,PGII <br /> f' UN3291,Regulated Medical Waste,n o s. Thi 2t? Cat 9Pttta 4g1 Y Cu Ft <br /> 6.2.PGII <br /> cc <br /> W UN3291,Regulated Medical Waste,n o s.. TPIS - ZP tna3 Tub {F a ttb? e'• e 'tt t@ j Cu Ft <br /> Z 62.PGII <br /> C.11 UN3291,Regulated Medical Waste,n.o s, r.,q; Tub QChc-01011 t?_7 ru f tt Cu FI <br /> 6.2.PGII <br /> UN3291,Regulated Medical Waste,n.o.s, g - Sj t.�.f � Ca.lydbe and S,ax !4-y c'a fes.' Cu Ft <br /> 6 2.PGII <br /> UN3291,Regulated Medical Waste,n o S. Cu Ft <br /> 6 2,PGII <br /> Cu Ft <br /> harjnaceuVACa1 V4Zt* <br /> 3.Generator's Certification:"I hereby declare that the contents of this consignment are fully and accurately <br /> TOTALS ® - Cu Ft <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 <br /> go <br /> vernmenregulations" <br /> Signature r <br /> Date <br /> Printed/Typed Name hone <br /> a t;559)',-'7 5-112 1 <br /> 4.TRANSPORTER 1 ADDRESS: This is a 'Ttt u stapmerrt Applicable Permit Numbers. <br /> ¢ Sterit-Wle, Inc. <br /> 4135 W. Swift Ave Cr <br /> t3al�aZet Flew t:lt:tn <br /> 4 a Frresno,rA 937'22 <br /> U) <br /> a a TRANSPORTER CERTIFICATION: Receipt of medical waste as described above. .� <br /> E/ Date <br /> ~ Print/Type Name V Signature <br /> Phone If: <br /> S.INTERMEDIATE HANDLER 2/TRANSPORTER 2 ADDRESS /.'. Applicable Permit Numbers <br /> W <br /> Vi <br /> W J <br /> n = INTERMEDIATE HANDLER/TRANSPORTER CERTIFICATION: Receipt of medical waste as described above. <br /> XT Signature Date <br /> Print/Type Name <br /> Phone N <br /> w 6.INTERMEDIATE HANDLER 3/TRANSPORTER 3 ADDRESS Applicable Permit Numbers: <br /> uaw <br /> O J <br /> o 2 a INTERMEDIATE HANDLER/TRANSPORTER CERTIFICATION: Receipt of medical waste as described above. <br /> W x Date <br /> W <br /> a Pnnt/Type Name Signature <br /> 7.DISCREPANCY INDICATION Tr.0saiNTed <br /> ou a to ; L*9.UT <br /> $ 80.Altemate Facility: <br /> E 8A.Designated Facility: <br /> 8B.Alternate Facility: 8C.Alternate Facility <br /> J � y`de,hC 1S atlCyt::ia, St <br /> ticytcte,tnr. Z?►5 -264h <br /> 4136 W.SWRAVO so NOM 1400�' r,CA ..3 +ltitTt:ir+,Cb 99E1a✓9 <br /> i Fresno.CA 93732 Afoa111 Bait 1.a7{fa,UT $4 r ra)3192-30410 <br /> 63G-I we <br /> T STSK)9n27&2 tat q 6 A-3b TSAO�3 T310ST-26 <br /> L <br /> +1 � TREATMENT FACILITY: I certify that I have been authorized by the applicable state agency to accept untreated medical wastes and that(have <br /> r s received the above indicated wastes in accordance with the requirement outlined in that authorization. <br /> _ 2 <br /> Date <br /> Print/Type Name Signature <br /> WAVEM H <br />