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Stockton, CA 952046117 <br />REl9LATORY Y: <br />Phare r: (209) 451-31 <br />Contact : <br />SUM'CE DATE: 4115114 9:06:45 A!1 <br />SHIPP[Idi DOCN o: 00 AR <br />� i N.O.S., <br />6.2, PGI I <br />For DOT HAZNAT Emergency Response Call: <br />CHENTREC 1-800-424 <br />Custer No. 21132 <br />TOTAL CONTAINERS COLLECTED: 1 <br />TOTAL MLIXIE COLLECTED: 5.900 CO FT <br />UOL <br />%MRY(Cont Type) QTY tF <br />T814 44 Gat Tub(Bio), CT 12.7 1 5.900 <br />�AOOErJ T814 �.. <br />I hereby declare twat t a�ca�t�ts of this <br />caisignment are fully and accurately <br />described above by the proper shipping <br />name, and are classified, packaged, marked <br />and labelled/placarded, and are in all <br />respects in proper condition for transport <br />according to applicable international and <br />national governmental regulations. <br />reyes <br />Generator Signature <br />Transporter Certification: Flores, Sal <br />Transporter Signature <br />[_[ THISWA THROB SHIP T. <br />[X] LOCAL TRANS CENTER <br />Stericycle-Fresh o,CA <br />DESTINATION FACILITY: <br />Incinerate Only <br />Stericycle-%rth Salt Lake,UT <br />3A-4481JA-36 <br />Dental Waste <br />Stericycle-Hol I ister,CA <br />Pharmaceutical <br />Stericycle-Kansas City,KS <br />H1564 <br />Standard <br />X Stericycle-Fresno,CA <br />DATE IE RECEIPT AT f <br />TREATtENT FACILITY: <br />DEC I VERY DRUM T N; OOEVAR <br />TOTAL DELI UE c - <br />I' -I <br />TEM QTY <br />