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Ingenlum Group LLC <br /> M(sslo�Avenue genium'*Escondido.CA 92025 <br /> 893 Ames Avenue Waste In.Green Out. <br /> Milpitas,CA 95035 <br /> Ph:760-745-8780 <br /> FX:76Q-745-8786 ®ICA WASTE TRACKING <br /> Generator/Address: Contact 124 Hour Emergency Phone lid <br /> mwaky 0120 Pacific <br /> 3W Pacift Aye 8 .5r3 <br /> Swcktm CA GWI <br /> Transporter 1: Transfer Station: (If Applicable) <br /> Ingenium <br /> 2280 Micro Place,Escondido,CA 92029 A1iel m <br /> DTSC Hazardous Waste Transporter Registration#4857 . <br /> 800-805-6236 <br /> 13esignatedDisposai 1 Trjhsfer racility:(Cneck One) <br /> ®Medlcal Waste Services t�Heaithwise Services [Nesithcare Environmental Services ®Curtis Bay Energy <br /> 7321 Quimby St 4800 E Ufiwln 1420 40th St NW 3200 Hawldns Point Rd <br /> Paramount,CA 90723 Fowler,CA 93625 Fargo,ND 58102 Baltimore,MD.21266 <br /> 888-610-1$11 855-246-9473 701-282-7373 410-354-3288 <br /> Permit#:TSIOST94 Permit#TS-89 Permit#.75/178001 Permit#.2005-WMI-0036 <br /> Shipping information: (Treatment Code: lAncineration,M=Microwave,A=Autoclave <br /> Description Count Cont.Type Est Wt. Actual Wt. Treatment <br /> UN 3291,Regulated Medical Waste <br /> 62 PG II ERG#158 BIOUN 3291, <br /> edical Waste <br /> 6.2 PG ti Regulated RG#1 8M IO INCIN J2V [iv, 'o01- <br /> UN 3291,Regulated Medical Waste <br /> 6Z PG 11 G#158 PATH <br /> UN 3291,Regulated Medical Waste <br /> 6.2,PG Il ERG#158 CHEMO <br /> Pharmaceutical Waste <br /> This is to certify that the materials described above are properly classified,packaged,marked and labeled and are in <br /> proper condition for transportation in accordance with the applicable regulations of the United States Department of <br /> Transportation and the State of California. <br /> Generator: <br /> Name(Print) Signature Date <br /> nsporter 1: <br /> Name(Print) Signal Date <br /> Transfer Station.: if A Ilcab e <br /> Name(Print) I� Signature Date <br /> Jf$/ <br /> Designaled Dis osai Tra sfer IFaclti <br /> 1V�tra(Print)��G� signs / Dat® . <br />