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For Stericycle Customer Care <br />Call1-666-783-7422 <br />Stericycle Customer t 6111852 <br />Site b 001 <br />Gill Medical Cater �''�"--��-' <br />1617 N California St <br />Stockton, CA 952046117 <br />REGLUTORY 4: <br />Phone t: (209) 451-9031 <br />Contact : <br />�RUICE ATE 2118114 9:55:41 AN-_�� �- <br />�,, <br />6.2, P611 <br />For DOT HQKAT Emergency Response Call: <br />DENTROC 1 -OW -424-9 0 <br />Customer No. 21132 <br />TOTAL CONTAINERS COLLECTED: 1 <br />TOTAL UOLUNE COLLECTED: 5.900 N FT <br />UOL <br />StINNARY(Cont Type) OTY CF <br />TB14 44 Gal Tub(Bio), CT 12.7 1 5.900 <br />M TB14 <br />I hereby declare t -mat t e�cw�tents of this <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 applicable international and <br />national governmental regulations. <br />nna rnsaner <br />�'/ <br />Generator Signature <br />Transporter Certification: Flores, Sal <br />Transporter Signature <br />[XI LOCAL TRANS CENTER <br />Ster icyc I of resno, CA <br />DESTINATION FACILITY: <br />Incinerate Only <br />Stericycle-North Salt Lake,UT <br />3A-4481JA-36 <br />Dental Waste <br />Stericycle-Hollister,CA <br />Pharmaceutical <br />Stericycle-Kansas City,KS <br />H1564 <br />Standard <br />X Stericycle-Fresno,CA <br />