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Print Name: <br />Signature: Li%1A/1 <br />Date: (7.12- <br />111111Manktel" : <br />DRIVER <br />Print Name: <br />Signature . <br />Date: <br />••••• Stericyclel <br />Protecting People. Reducing Risk:* <br />NON-HAZARDOUS WASTE SHIPPING DOCUMENT <br />Phone: 866.783.7422 <br />Website: www.stericycle.com <br />of,d4o0oqi-i-- Generc:tfr's Name, Address & Telephone Nu4 ber <br /> <br />vo., Trci LA., cD( 1 as <br />(607 -s. 4Kalt)‘ ctil-- <br />s-9 A-op Customer # ( <br />Waste Description Number of Containers Total Cubic Feet Weight Type <br />Gallon <br />Non-RCRA Waste <br />(photachemical/photoprocessIng waste) DWI I <br />universal Waste (containing Mercury & <br />Aqueous Solution) (Dental Amalgam)i DW2I <br />4......-7'..."......"7-----*/ <br />Gallon <br />Universal Waste From Dental X-Ray <br />Unit (Scrap Metal Lead Foil) DWO3 LS <br />.111101111111101111~Rat: <br />GENERATOR <br />RETAIN COPY FOR THREE YEARS <br />001-93NN (18EV 1/18)