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so <br />e Stericycle' <br />SE OF EMERGENCY CONTACT: CHEMTREC 1.800.49 <br />to #: 317 - 7 Customer 'No. <br />1. Generator's Name, Address and Telephone Number <br />,ATTN; Caria Vallem/Project <br />BIO/ST JOBS INMED CAPS/OCCBLTH <br />1801 E. MARCS LAME BLDG 470D/480D <br />Si'OCK' ox, CA 95210 <br />2B. <br />467-6395 <br />STANDARD MANIFEST 001.10-WSTD <br />i DFRO®A61L <br />fill —111-il]j <br />GENERATOR'S REotsTRATioN # <br />CONTAINERTYPE 2C. NO. OF <br />CONTAINERS <br />8802/RS02 — 2 eal Sharps Reusable (0.3 cu ft) <br />ss03/R303 — 3 Gal Sharps Reusable (0.4 cu ft) <br />SSOS/RSOS - 8 Gal Sharps Reusable (1.1 cu ft) <br />SS17/RS17 - 17 Gal Sharps Reusable (2.3 cu ft) <br />TB02 - 150 Gal Reusable (17.4 cu ft) <br />KR65 - wheeled Rack (59.4 cu tt) <br />Di.o stems kart or Box C4 / ro CU rt) <br />Waste. 6.3. U1x3391. :ILTOTALS ► <br />3. Generator's Certification: "I hereby declare that the contents of this consignment are fully and accurately <br />described above by the proper shipping name, and are classified, packaged, marked and labelled/placarded, and <br />are in all respects in proper condition for transport according to applicable international and national governmental regulations' <br />11/17/201( <br />VOLUME <br />13 <br />i 'PrintedlTyped Name I r 4/ Signature Dat - <br />4.TRANSPORTER 1 ADDRESS: Phone #•CC (559) 275 - <br />SteTr icycle, Inc. Applicable Permit Numbers: <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Q <br />w <br />TREATMENT FACILITY: I certify that I have bee ized by the applicable state agency to accept untreated medical wastes and that I have <br />received the above indica he requirement outlined in that authorization. <br />,i <br />Print/Type Name Signature <br />Date <br />i,LF- 1..ii 414110 2!� <br />