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Girl QTcal Center <br />1617 H California St <br />Stockton, CA 952046117 <br />REGULATORY /: <br />Plane t: (209) 451-9031 <br />Contact : <br />SERVICE DATE 2!25!14 10:07:10 AN_. _-'- <br />� . , � iu, ear t� _•�' � <br />6.2, PGI I <br />for DOT HAZHAT Emer� ccy Response Cal I: <br />CHENTREC 1-,-424-90 <br />Customer No. 21132 <br />TOTAL CONTAINERS COLLECTED: 1 <br />TOTAL VOLUME COLLECTED: 5.9DO CU FT <br />VOL <br />SLMARV(Coit Type) DTV CF <br />TB14 44 Fal Tub(Bio), CT 12.7 1 5.900 <br />OIOAOQfiI TB14 - - - - <br />I hereby Dare- that he contents of !his <br />consignment are fully and accurately <br />described above by the proper shipping <br />name, and are classified, packaged, marked <br />and label led/placarded, and are in all <br />respects in proper condition for transport <br />according to appl!cable international and <br />rational governmental regulations. <br />reyes <br />Generator Signature <br />Transporter Certification: Flores, Sal <br />Transporter Signature <br />------- <br />[Xj LOCAL. TRANS CENTER <br />Stericycle-Fresno,CA <br />DESTINATION FACILITY: <br />Incinerate Only <br />Stericycle-North Salt Lake,UT <br />3A-446/JA-36 <br />Dental Waste <br />Stericycle-Hol I ister,CA <br />Pharmaceutical <br />Stericycle-Kansas City,KS <br />H1554 <br />Standard <br />X Stericycle-Fresno,CA <br />DATE OF RECEIPT AT <br />TREATMENT FACILITY - <br />MCI VW <br />ACiLiTY:MIV DOCUMI x: DFR00 -- - <br />rij <br />