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For, Ster!cycle Customer Care <br />Cal 1 1-866-783-7422 <br />Stericycle Customer 16111852 <br />Site 1001 <br />6711 Medical Center — <br />1617 N California St <br />Stockton, CA 952046117 <br />REGLILATORY t: <br />Phone 1: (209) 451-W31 <br />Contact : <br />SER—VI(—BATE: 2111114 10:54:37 <br />SHIPPIlV6 DO(3kl �: RAE-�----- <br />291,ASTIN.D.S., <br />6.2, PGI I <br />For DOT HAZHAT Emergency Response Call: <br />CHENTREC 1 -800 -424 -MOO <br />Customer No. 21132 <br />TOTAL CONTAINERS COLLECTED: 1 <br />TOTAL VOLUME COLLECTED: 5.900 CU FT <br />VOL <br />Sl1NNARY(Cont Type) OTY CF <br />T014 44 Gal Tub(Bio), IT 12.7 1 5.900 <br />OOAOil6E T�14 _ . <br />I hereby declare t at t contents of th s <br />consignment 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 />Generator Signature <br />Transporter Certification: Flores% Sat <br />Transporter Signature <br />[_j THIS IS A GH I WNT. --- '- <br />[XI LOCAL TRANS CENTER <br />Ster icycle-Fresno,CA <br />DESTINATION FACILITY: <br />Incinerate Only <br />Stericycle-North Salt Lake,UT <br />3A-4481JA-36 <br />Dental Waste <br />Stericycle-%I l ister,CA <br />Pharmaceutical <br />Stericycle-Kansas City,KS <br />H1564 <br />Standard <br />X Stericycle-Fresno,CA <br />