Laserfiche WebLink
®• Steeicycle' <br />• PMKUM ftopk. Rdndng OW <br />SE OF EMERGENCY CONTACT: CHEMTREC 1-8011.234 STANDARD MANIFEST 001 -10.06 -STD <br />Route #: 301 - 13 MDF'R0084 KN <br />1. Generator's Name, Address and Telephone Number <br />ATTN: Caria Vallem/Project M <br />BIO/ST JOBS IMMED CARE/OCCHLTH <br />- <br />1B01 E. MARCH LAME BLDG 470D/480D <br />STOCKTON, CA 95210 <br />(209) 467-6395 <br />7/1/2009 <br />CUSTOMER NUMBER 6062804-003 GENERATOR'S REcisT'RATion# <br />2A. DESCRIPTION OF WASTE <br />28. CONTAINERTYPE <br />2C. NO. OF <br />2D. VOLUME <br />UN 3291TED MEDICAL WASTE n.0.s.,6.2 <br />UN 3291, PG it DOT- �P <br />BS02/RS02 - 2 tial Sharps s Reusable 50.3 cu ft) <br />p <br />CONTAINERS <br />Cu Ft. <br />REGULATED MEDICAL ,, n.o.s.,6.2, <br />UN 3291, PG 11 <br />BS03/RS03 - 3 Gal sliar s Reusable (0.4 cu tt) <br />Cu Ft. <br />®REGULATED <br />MEDICALW�ASTEwes.,6.2, <br />BS08/RSOB - B Gal Sharps Aeusable (1.1 cis ft) <br />UN 3291, PG tl <br />Cu Ft. <br />Q <br />REGULATED MEDICAL WASTE, n.o.s.,6.2, <br />BS17/RS17 - 17 tial Sharps Reusable (2.3 cu ft) <br />UN 3291, PG II DOT- SF <br />Cu Ft. <br />W <br />REGULATED MEDICAL WASTE, n.o.s.,6.2. <br />TB02 - 150 Gal Reusable (17.4 cu ft) <br />UN 3291, PG 11 <br />Cu Ft. <br />IZ <br />REGULATED MEDICAL WASTE, n.o.s.,6.2, <br />UN 3291, PG 11 <br />Cu Ft. <br />REGULATED MEDICAL WASTE, n.o.s.,6.2, <br />R X Q 1 S C 'Y 3 <br />�' <br />UN 3291, PG II <br />O X I i'7 ' C.tJ�- <br />Cu Ft. <br />REGULATED MEDICAL WASTE, n.o.s.,6.2, <br />UN 3291, PG II DOT—SP 13 <br />RRbS _ Wheeled Rack (59.4 cu ft) <br />Cu Ft. <br />Regulated Medical <br />KR Bio Systems Cart or Box { cu ft) <br />Cu Ft. <br />3. Generator's Certification: "I hereby declare that the contents of this consignment are fully and accurately T®TALS ® <br />4-.3 Cu Ft. <br />described above by the proper shipping name, and are classified, packaged, marked and labelled/placarded, and <br />are in all respects in proper cGndjijpn for transport according to applicable international and national governmental regulations" <br />1P1Signature <br />7 0 017 <br />Printed/Typed Name <br />Date <br />4. TRANSPORTER 1 ADDRESS: <br />stericycle, Inc. <br />Phone#: (559) 275 — 0994 <br />Applicable Permit Numbers: <br />4135 West Swift Ave. <br />This is Theou shipment <br />Fresno,Ca 93722 <br />a a <br />TRANSPORTER CERTIFICATION: Receipt of medical waste as/crnibed a . <br />U' <br />% LIDq <br />Printlrype Name Tw1rY'YL� Signat <br />Dale <br />5. INTERMEDIATE HANDLER 2 /TRANSPORTER 2 ADDRESS: <br />Phone #: <br />Applicable Permit Numbers: <br />q <br />$M8 <br />°C <br />INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Receipt of medical waste as described above. <br />Print/Type Name Signature <br />Date <br />6. INTERMEDIATE HANDLER 31 TRANSPORTER 3 ADDRESS: <br />Phone #: <br />u�i g <br />Applicable Permit Numbers: <br />�a <br />INTERMEDIATE HANDLER /TRANSPORTER CERTIFICATION: Receipt of medical waste as described shave. <br />— <br />Printfrype Name Signature <br />Date <br />7. DISCREPANCY INDICATION <br />L.Ku C- U -r <br />Tans d ®3 containers, cu ft to NLtA1, <br />8A. Designated Facility: 66. Alternate Facility: Ll 8C. Alternate Facilay: <br />8D. Altern.9 acility: <br />STERICYCLE INC STERICYCLE INC STERICYCLE INC <br />STERICYCLE INC <br />a4135 <br />W. SWIFT AVE So NORTH 1100 WEST 9053 NORRIS AVE, <br />2775 E 26TH STREET <br />FRESNO,CA 93722 NORTH SALT LAKE CITY. UT SUN VALLEY, CA 91352 <br />VERNON. CA 90023 <br />(559) 275 - 0994 (60 t) 936 - 1555 (818)504- 6937 <br />(323) 362 - 3000 <br />Z <br />TS31, TS/OS'T25TS/OS 2 Class V Incineration PenTjW 91 022 P-6, P-115 <br />JGQ E WILSON <br />a <br />W <br />TREATMENT FACILITY: 1 certify that I have been authorized by the applicable state agency to accept untreated <br />medical wastes and that I have <br />received the above indicated wain +c�6pr with the requirement outlined in that authorization. <br />1 J <br />Print/Type Name Signature <br />Date <br />eG0 3 <br />