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24-Hour Emergency Phone Tracking Document Number: <br /> Number: 888.785-7225 <br /> ACTMedical Waste Tracking Document <br /> environmental services <br /> Facility Name: Manteca Urified School Dist(marrteca w Name: Kimberley Wright <br /> Z 450 E.Yoserrtte Ave <br /> LU <br /> a Address: M-ant—SrUaCA 195,13- Phone: <br /> r <br /> Shipping Description(s) #of Cont Cont. Size Estimated Actual *Treatment <br /> Type Weight Weight <br /> UN 3291,Regulated Medical Waste, N.O.S. <br /> 6.2, PG 11 <br /> Z UN 3291, Regulated Medical Waste, N,O.S. <br /> 6.2,PG II (Pathological Waste) k1 (J131 1 <br /> 3 /4a <br /> UN 3291, Regulated Medical Waste, N.O.S. <br /> 0 6.2,PG 11 (Chemotherapy Waste) <br /> z <br /> c� <br /> Z Non-Hazardous Pharmaceutical Waste <br /> 6 <br /> a. <br /> Ift <br /> x <br /> Non-Regulated <br /> Other(specify): <br /> A =Autoclave, 1=Incineration, M=Microwave <br /> Advanced Chemical Transport,Inc. CA Hazardous Waste Registration:4026 <br /> 1210 Elko Drive, Sunnyvale,CA 94089 EPA ID#:CAR000070540 <br /> = Motor Carrier Permit:0194741 <br /> 0 <br /> R ❑ 1210 Elko Drive ❑ 2010 Mission Ave, [ 265 Riggs Avenue ❑ 13722 Carmenita Road <br /> Lo a Sunnyvale,CA 94089 Escondido,CA 92029 ' Merced,CA 95341 Santa Fe Springs,CA 90670 <br /> 0u 408-548-5050 760-489-56DO 209-722-4228 714-545-2191 <br /> MWTS Permit#TS-42 lF MWTS P rmit#fS-104 MWTS Permit#TS-8 <br /> Print Name: FlY,( , * '`; I y` {,��1 Signature: f Date: c�3 f i <br /> LULU <br /> a Name: DOT#: <br /> D=Q Address: State Transporter#or Permit: <br /> W K <br /> h <br /> Print Name: Signature: Date: <br /> Z I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, <br /> o marked and labeled,and are in all respects in proper condition for transport according to applicable governmental regulations. I certify that this shipment does <br /> a not contain regulated hazardous and or radioactive waste. 1 am aware that there are significant penalties for submitting false information including the possibility <br /> wof fines and imprisonment. <br /> zlu cc� <br /> 0 W F •I 4 i <br /> Signature: ! `_r ` _ Print Name: ��r - r{ Date: ' <br /> I i <br /> Advanced Chemical Transport C:] ACT Medical E] Advanced Chemical Transport Advanced Chemical Transport <br /> 1210 Elko Dnve 2010 Mission Ave. 265 Riggs Avenue 13722 Carmanita Road, <br /> W z Sunnyvale,CA 94089 Escondido,CA 92029 Merced,CA 95341 e-�_�gs�.�NY670 <br /> u.0 408.548-5050 760.489-560D 209.722-4228 � -t. -2159'' 2, <br /> q MWTS Permit#TS-42 Permit#TSlOST-fib MWTS Permit#TS-100 MWTS Permit#TS-6 <br /> in <br /> ~ THIS IS TO CERTIFY THAT THE WASTE IDENTIFIED ABOVE WAS <br /> RECEIVED AT THE TRANSFER FACILITY CHECKED ABOVE- Signature& Date: <br /> ❑ ACT Medical ' Healthwise Services Medical ❑ Waste Management Healthcare Other <br /> 2010 Mission Road Waste Disposal Solutions <br /> O y Escondido.CA 92029 4800 E.Lincoln Ave Fowler 4280 Bandin{Blvd <br /> 760-489-5600 California 93625 Vernon,CA 90056 <br /> z!4 Permit TSfOST-66 559-834-3333 323-307-0514 <br /> wa Permit#TS-39 PermiL#TSIOST-81 <br /> W <br /> THIS IS TO CERTIFY THAT THE WASTE IDENTIFIED ABOVE WAS <br /> RECEIVED AT THE DESTINATION FACILTTY CHECKED ABOVE. Signature&Date: <br />