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11/12/2010_ 14:19 2092395& BUSINESS OFFIC PAGE 21 <br /> 0" 01 MECHCAL WASTE T KING FORM!NUb1®ER <br /> 060-0 sterkyde. BN CASE OF GVEIRCIENCY CoMTACP;pl C I-N&2344 STANDAPID MANIFEST 001-10-I6-970 <br /> t.Generalor's Name,Address aria-rempnomNumber <br /> AT7N: Cathy/Maxine II 1 II I I <br /> 410 gASTWOou AVE <br /> MAWMA, CA 95336- 3167 <br /> CUSTr>WR IR KIM 09IERATOR'S REGMTRANON R <br /> zA DESGRIPn(9NOFtM CONTAINERTYPE 2G,NO.OF 20, VOLUME <br /> REGULATED MEDICAL WASTE,n.o.&.6.2. CONTAINERS <br /> UN 3291,PG II Cit F1, <br /> I AOdULATED MEOICAL WASTE, <br /> LIN 3291.PG 11 _ d 11 s>��t�1 nF Cu Ft. <br /> IZ REGULATED WDICALWASM n,o.s..6.2. Z `a <br /> Q UN 3291,PG II _ Cu PI, <br /> Q REGULATED FADE AL WASTI,n 4,F„6.2. <br /> cc UN 3291,PG U 'T921 - 20 041 Tub Me 2.7 cu 4t) <br /> W REGULATED IVMIGAL WASTt'Ao,s,.6.21 <br /> W UN 3291.PG It ®_GAJI Ih [ -A- 42-1-C1t III:) CU Fl. <br /> C3 ftEWLATED MEDICAL WASTE,n.o.s..S.2, <br /> UN 3291.PS II Cu <br /> REGULATED MEDICAL WASTE,R.o.s.,6.2, <br /> LIN 3291,PG it CU Ff. <br /> REGULATED W41r,At.WAUTE,o.o.s,.A2. — <br /> UN 32„91,PG 11 <br /> _ Cu PL <br /> 3.Gamldloea Certification;'i hereby declare fti the oenlenta of Ihis compm en1 ate Why and accurately T®TALS► �, �j <br /> described above by the proper stmppame.and�re classified,p,acmp”,matkad and labma lde /ptaoarde�and-! Cs1 Ft. <br /> W" a <br /> mq n <br /> erg in oil reApern:In proper condi!lon for tmnepvt According to appflcsGsA intrrrnalacnnl end nafionetn " I f. An - <br /> ,�/l <br /> lPrinledri'yped Nanus� ���G'�• - Sigheiu U81B_.-.... fQ <br /> 4.TRANSF'ORiq t ADDRESS: Phona a; 75 - 4994 <br /> O 5tex icycle, A nc. AotdlcdWtf Pr,,�w�ti bele. <br /> 4135 west Swift Ave. <br /> a ® This isThrou h Shipment <br /> v 4 I TIIA�lSPQRTEf 7 Ot mgdlr&pl wt+?1e.as d?4MA9�v R'T? <br /> I" J <br /> PrintlTypo Name �• q Signalvre _ DAi4 (® <br /> S.INTPRMEMATE HANDLER 2 r TRANgP()RTFR 2 At)DRFSS: Ptmnn it: <br /> �6 ApprM,eiyA PHPmit Ntrmbors; <br /> INTERMEDIATE HANDLER ITRANSPOSTER CERTIFICATM:Receipt of meds wine an rmscrihnd Ixn. <br /> i <br /> Pti lt/TTypo Namv $iSRglnlrn 11Ate <br /> i <br /> c+� 6.INTERMEDIATE HANDLER 3/TRANSPON T ER 3 ADDRESS: >"hd+e 0: <br /> Ey fi AptdeylXe pPPrnit <br /> � <br /> W INTERME€)IATew HANDLER 1 TRAN9SPICITIVFI CE"FICATIOIY_Revcipl o1 modical Wasto ris dewribea above. i <br /> Print/Type Name Signr tune 'Dale <br /> 1 T.04 EPANCY ININCATION i <br /> CIA.Dmsignetod r-otlMr. fenrlm . P ' u .A ccnatA F,uI tin,nitnmatn Fmerilty: <br /> K r r <br /> v ' lt"CYCLE tNC CTMCYCLE INC STERICYCL.E INC BICYCLE INC <br /> LL 4136 W.SWF T AVE so{9O"1 lacVVEST 3063 NORMS AVE. 2718 E STREETFRESNO,CA 23722 1110,, SLIT LAI"'CITY.UT S41tH 1dA1 Y.CA 9 x 352 VERNON,CA 93823 <br /> (55'9)277-Q99a (801)936-t655 (a 18)5%-S937 (32313U-30M <br /> 7;31,TS/OSZA TSIOSi22 Chi J 1 on Pe 99 2 P-&.P-115 <br /> W TREATMENT FACILITY: I eerily that 1 have been 3,utticwizad by lila APP-Al:aehle 105tMgene sept lent 910d medical wastes and that I hiRve <br /> received the above indicate at accordance with Qh0 re4Ulr0MGr.L „m that <br /> APR 0 6 ZOT <br /> pdnt/l'ypo Namt) �7- `�:.ignntu� Date <br /> I <br />