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Non-Hazardous Waste shipping Documentation <br />EcoSolutions a division of Stericycle Inc <br />Generator <br />y0 <br />ol Tr(v) <br />o7$ A/4)vi: <br />40,c 1313 r1 <br />Info: /419,fge4 LT 0,5 Acct# PrigS-7-1- s. °I <br />Waste Description # of containers Total Quantity wtNol <br />Non-RCRA Waste <br />photochemicals/photoprocessing waste <br />No type <br />Gal DW 11 <br />Universal Waste (Dental Amalgam) <br />containing Mercury and Aqueous Solution / DW21 <br />.. A 7 <br />Gal <br />Universal Waste (Lead foil) <br />From Dental X-Ray unit DWO3 LBS <br />, <br />Generator Print Nam • _ I./ _...." .. Date: f <br />Generator S n ture: <br />OF <br />/ rd <br />Drivers Print Name: <br />/ <br />4 <br />pr y, <br />, Date: <br />.."'" <br />Drivers Signature: ..,41111N1111111111111‘1.1111110 <br />For any question please Conta t • ur Customer Service <br />1-866-783-7422 <br />RETAIN COPY FOR 3 YEARS