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Ingenium Group LLC <br /> 955 W. Mission Avenue <br /> Escondido, CA 92025 n g e n i u m Docil <br /> 893 Ames Avenue F, Waste In . Green Out . <br /> Milpitas CA 95035 `:O 15'1844 <br /> PH: 760-745-8780 <br /> FX: 760-745-8786 MEDICAL WASTE TRACKING DOCUMENT <br /> Generator / Address: Contact / 24 Hour Emergency Phone # <br /> TUSD - Kimball High School <br /> 3200 Jaguar Run W4-( J3-11263 <br /> Tracy, CA 95377 <br /> Transporter 1 : Transfer Station: (If Applicable) <br /> IngeniumIngonium <br /> 2280 Micro Place, Escondido, CA 92029 6063 Foodlink St <br /> DTSC Hazardous Waste Transporter Registration #4857 Sacramento, CA 95828 <br /> 800-805-6236 800'805"6235 Tr.3ster Station # <br /> Designated Disposal / Transfer Facility: (Check One) <br /> ❑ Medical Waste Services ❑ Healthwise Services ❑ Healthcare Environmental Services ❑ Curtis Bay Energy <br /> 7321 Quimby St. 4800 E Lincoln 1420 40th St, NW 3200 Hawkins Point Rd <br /> Paramount, CA 90723 Fowler, CA 93625 Fargo, ND 58102 Baltimore, MD 21226 <br /> 888-610-1311 855-246-9473 701 -282-7373 410-354-3228 <br /> Permit #: TS/OST94 Permit #: TS-89 Permit #: T5/178001 Permit #: 2005-WMI-0036 <br /> Shipping Information: (Treatment Code: 1=Incineration , M =Microwave, A=Autoclave <br /> ✓ Description Count Cont. Type Est. Wt. Actual Wt. Treatment <br /> UN 3291 , Regulated Medical Waste <br /> 6.21 PG II ERG#158 / BIO <br /> UN 3291 , Regulated Medical Waste <br /> %6.2, PG II ERG#158 /BIO INCIN <br /> UN 3291 , Regulated Medical Waste �'. T � <br /> 6.23 PG II ERG#158 PATH <br /> UN 3291 , Regulated Medical Waste <br /> 6.23 PG II (ERG#158) CHEMO <br /> Pharmaceutical Waste <br /> This is to certify that the materials described above are properly classified, packaged, marked and labeled and are in <br /> proper condition for transportation in accordance with the applicable regulations of the United States Department of <br /> Transportation and he State of California. <br /> Generator: <br /> Name (Print) i _ Signature / Date <br /> am <br /> Transporter 1 : / <br /> Name (Print) Signature . // Date <br /> rA) <br /> Transfer Station: If Applicable) <br /> i <br /> Name.(Print) Signature Date <br /> ��J d ��i1 ( J�'yG+ ✓ p6 v(o � 19 <br /> Designated Disposal / Transfer Facility: <br /> Name (Print) Signature Date <br />