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24-Hour Emergency Phone I Tracking Document Number: <br /> 1 _ Number: 888-785-7225 <br /> � _ • <br /> ACTMedical Waste Tracking Document <br /> environmental services <br /> 0 o Facility Name: Mar-towUrifted School dist(MantaM Kill Name: Kimberiey WrigN <br /> W 450 E. Yosemite Ave <br /> Z 0 <br /> Z Address: Manteca, CA 95.336 Phone: 209-858-0860 <br /> y Shipping Descriptions) #of Cant Cont. Size Estimated Actual `Treatment <br /> Type Weight Weight <br /> UN 3291, Regulated Medical Waste, N.O.S. <br /> 6.2,PG 11 <br /> 0 UN 3291, Regulated Medical Waste, N.O.S. <br /> 0 6.2, PG II {Pathological Waste) <br /> a <br /> UN 3291, Regulated Medical Waste, N.O.S. <br /> ° 6.2, PG II (Chemotherapy Waste) <br /> 0 <br /> z <br /> Z Non-Hazardous Pharmaceutical Waste <br /> a <br /> a_ <br /> x <br /> N <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 /> flif LW= Motor Carrier Permit:0194741 <br /> 0 <br /> ❑ 1210 Elko Drive ❑ 2010 Mission Ave. 0 265 Riggs Avenue ❑ 13722 Carmenita Road <br /> m Sunnyvale, CA 94089 Escondido, CA 92029 Merced,CA 95341 Santa Fe Springs,CA 90670 <br /> z 408-548-5050 760-489-5600 209-722-4228 714-545-2191 <br /> ~— MWTS Permit#TS-42r' // MWTS Permit#TS-100 MWTS Permit#TS-8 <br /> Print Name"4-(4 , ignature'.. � C��� �� Date: <br /> tr <br /> c i- Name: DOT#: <br /> 00 <br /> o Address: State Transporter#or Permit: <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,andare classified,packaged, <br /> a:o marked and labeled,and are in all respects in proper condition for transport according to applicablertif <br /> governmental regulations. I certify that this shipment does <br /> aa not contain regulated hazardous and or radioactive waste I am aware that there are significant penalties for submitting false information including the possibility <br /> SnQs end imprisonment <br /> W LL <br /> Ui <br /> gnature: t� +{� �.� I .� IPrintName t�' ��IL� i��1�,` T Date: <br /> Advanced Chemical Transport ❑ ACT Medical ❑ Advanced Chemical Transport Advanced Chemcal Transport <br /> 1210 Elko Dnve 2010 Mission Ave. 265 Riggs Avenue _�] 22' arinel'fifa•f�6ad, <br /> w z Sunnyvale,CA 94089 Escondido,CA 92029 Merced,CA 9534. Tanta Fe Spnn4$`CA 90670 <br /> r`0 408-548-5050 766-469-5600 209-722-4228 714-545-2191 <br /> N <br /> ¢a MWTS Penni[#TS-42 Permit#75l057-66 MWTS Permit#TS-760 MWTS Permit N TS-8 <br /> ~ THIS iS TO CERTIFY THAT THE WASTE IDENTIFIED ABOVE WAS <br /> RECEIVED AT THE TRANSFER FACILITY CHECKED ABOVE. Signature&Date: <br /> ACT Medical Hean ise Services Medical ❑ Waste Management Healthcare ❑ Other <br /> Z 2610 Mission Road rite Disposal Solutions <br /> O} Escondido,CA 92029 4 E. ineoln Ave Fowler 4280 Bandini Blvd <br /> I— 760-489-5800 California 93625 Vernon,CA 90056 <br /> Z Permit rt TSIOST-fib 559-834-3333 323-307-0514 <br /> I a Permit#TS-39 Permit p TS/OST-81 <br /> n THIS IS TO CERTIFY THAT THE WASTE IDENTIRED ABOVE WAS <br /> RECEIVED AT THE DESTINATION FACILITY CHECKED ABOVE- Signature&Date: <br />