Laserfiche WebLink
O <br />4 <br />tY <br />W <br />Z <br />W <br />a <br />®•® 5teriicycle' <br />®rye -n!" how. Ruing Rbk; <br />SE OF EMERGENCY CONTACT: CNEMTREC 1600-424 'STANDARD MANIFEST oot.lo•or--STO <br />to #: 317 -- Cuatomer No. 2 MDFROOA3XD <br />1. Generator's Name, Address and Telephone Number <br />ATTN; .;aria Valletn/Project <br />BIO/ST `TOES INWD CARE/OCC13LTH <br />1801 E. MARCH LAIIE BLDG 470D/480D <br />STOCKTON, CA 95210 <br />QII9191VII�911191pIIIIIIIlAl1111 <br />(209) 467-6395 <br />11/3/201( <br />CUSTOMER NUMBER 6062804-003 GENERArowsREGISTRAnoN# <br />2A. DESCRIPTION OF WASTE <br />UN3291. Regulated Mi W , n.o.s., <br />6.2. PGII <br />28. CONTAINERTYPE <br />13s02/RS02 — 2 Gal sharps Reusable (0.3 cu ft) <br />2C. NO. OF <br />CONTAINERS <br />2D. VOLUME <br />Cu I <br />UN3291, Regulated Me l aril W Slee, n.o.s., <br />6.2, PGII <br />BS03/Rs03 -- 3 Gal Sharps Reusable (0.4 Cu ft) <br />A <br />Cu i <br />UN3291, Regulated Mei W , n.o.s., <br />6.2, PGII <br />gS08JR808 — 8 Gal $harps Reusable (1.1 cu ft) <br />INTERMEDIATE HANDLER /TRANSPORTER <br />Cu I <br />UN3291, Regulated Medical Waste, n,o.s., <br />6.2, PGII DOT—SP <br />13317 RS17 — 17 Gal Sharps Reusable (2.3 Cu ft) <br />i <br />Pdrit/Type Name <br />I Cut <br />UN3291. Regulated Medical Waste, n.o.s.,[ T802 — 150 Gal Reusable (17.4 cu tt) I I_ <br />Regulated <br />UN3291, Regulated Medical Waste, n.o.s,. 1119'� <br />6.2, PGII " <br />UN3291, Regulated Medical Waste, mos., KR65 — Wheeled Rack 159.4 cu ft) <br />6.2, PGll DOT—St? 13 <br />Regulated Medical KR - Bio Systems Cart or Box { Cu ft) <br />1. <br />3. Generator's <br />s atori's CertificaCertification: '7 hereby declarethat the contents of this consignment are fully and accuratelyTOTALS 10, <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 apPiicat#�ntemational and national govemme"I regulations' n <br />Printed/Typed Name is <br />4SPORTER iADDRESS: <br />Stericycle, Inc. <br /> <br /> <br />PdnUType Name _ <br />of medical waste as <br />i:sl is a Through shipment <br />0 <br />Cul <br />I I `4 A••# cut <br />!t/__ Date +� — /o <br />Prone #: (559) 275 - 0 <br />Applicable Permit Numbers: <br />Dale / ! ~% " f <br />5. INTERMEDIATE HANDLER 2 /TRANSPORTER 2 A99REeS. one #: <br />+�+ <br />Applicable Permit Numbers: <br />IN <br />A <br />R <br />INTERMEDIATE HANDLER /TRANSPORTER <br />CERTIFICATION: Receipt of medical waste as described above. <br />Pdrit/Type Name <br />Signature <br />Date <br />6. INTERMEDIATE HANDLER 3/TRANSPORTER 3 ADDRESS: <br />Phone #: <br />Applicable Permit Numbers: <br />o �+ <br />J <br />c a i <br />INTERMEDIATE HANDLER /TRANSPORTER <br />CERTIFICATION: Receipt of medical waste as described above. <br />Print/Type Name <br />Signature <br />Date <br />7. DISCREPANCY INDICATION <br />Tran famed cu A to : North Salt Lake, UT <br />___,containersr <br />6A. Designated Facility: <br />$8. Alternate Facility: OC. Attemate Facility: <br />so. Alternate Facility: <br />Stedclide Inc Autodave <br />Sterlcyde Ino- Indneraflon Stericyde Inc -Agave <br />Sterlcyde Inc-Autodave <br />4 <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />w <br />_ (� <br />to <br />that I have <br />TREATMENT FACILITY: I <br />u onzed by the applicable state agency accept untreated <br />medical wastes and <br />received the above indicated wastes in accordance with the requirement outlined in that authorization. <br />Print/Type Name <br />NUV A-6-220— Signature <br />Date <br />1.:tO �t�•� <br />