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••• ••• Stericycle <br />• <br />° • Protecting People. Reducing Risk: <br />NON-HAZARDOUS WASTE SHIPPING—DOCUMENT <br />Phone: 866.783.7422 <br />Website: www.stericycle.com <br />Generator's Name, Address & Telephone Number <br />\i T Or, 00 nib <br />()D-1 S‘ Owl Str-ePr <br />Ifoifylan eik —5-7D <br />Customer # t00% 't -1i -CV <br />fil0 -g-oz)P-Avel9 <br />(oct) qz-W <br />' - Waste Description • <br />Non•IICRA Waste <br />(photothemIcaliphotopnacessing waste) . <br />Number Of Containers <br />Number Type <br />- Total Cubic Feet Weight Type <br />Gallon <br />Enter Amount Here <br />, <br />DWI I - <br />Universal Waste (containing Mercury & <br />Aqueous Solution) (Dental Amalgam) \ DWI2 < Gallon <br />Universal Waste From Dental X-Ray <br />Unit (Scrap Metal Lead Fall) DWO3 LBS <br />, <br />GENERATOR <br />Print Name: l's, S-I-c I MC) I/ n <br />Signature: <br />I. <br />i 41 ajoy.LD <br />Date: e- p74,1 e <br />DRIVER <br />Print Name: S "t1411A g (r)(°4 4 <br />Signature: Ctri---X <br />Date: q -11-1-ce <br />RETAIN COPY FOR THREEYEARS <br />001-93A/N (REV 0/17) <br />c)