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Versailles Salon — 1010 Central Ave., Tracy CA 95376 PR0541621 <br /> February 6, 2022 <br /> PHOTO 4:�TT'hee white copy of the Stericycle manifest was not available for review. <br /> _ ,� .� A.i '- •, r�. _ � ter. a. r — .�� _ - _. <br /> i7k Manifest ID �; <br /> ` rat . � • • - 3743353 <br /> r r _s • •�� � - ..�" �•e . -1-.;F,�.,�, r- r^ ;� • •• Stericy`!Protecting P People.Reducing Rlk <br /> IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIillll � _ . _ :�. �: � <br /> t `, I Jr r - r� r.' .�•j RACK <br /> W.\SrliT IN GDOCUMENT-1\fANIFEST LC y <br /> y � o orm a[ion In SeUio and core lete <br /> _ Scctioa2 • �� _ �O ��' 3. Xeep the bot[on+ (blue) copy.(oryour retards z <br /> - <br /> r` +leper ba <br /> = g on the outride aj[!+e return bor , <br /> ` r .� A ` = •+� "f certify that this container has been a Cene - i <br /> Frotor(MoJcr) CcrtJrnlion <br /> F . •�:;�' been Prepared for PProvcd for the moiling of rcgajawd medical w.1e or sharps wute (m noted below), -,• _ �.,• <br /> r has - -� <br /> •+- no ma,LnF in occorda does not canuin excess li aid or <br /> nmailable material in nee with the directions for that purpose, and 9 nw y `��'„ - A• <br /> l _ violation of the applicable <br /> RESPONSIBILITY RESTS WITH T ORPostal Service regulations. l AM AWARE THAT RILL <br /> MAY RESULTPLACING <br /> HE GENERATOR (MAn�R) FOR ANY VIOLATION OF 78 USC 1716 WHICH �� �• ' ~� <br /> IC w� this concignmcnt RareOMlly1 ndIN MPROP y RI ERLY PACKAGED ITEMS IN THE MAIL f also certify that the contents of !y_ _�, C •� <br /> y labeled,and in proper y described about b proper shipping name and are dussificd. pucke4 rrrarkcd, and <br /> 'a ryT7° P per conditlon for y p pp g <br /> i - r ►k- (�! - corriage by all according to the national governrnenlal regulations.' j <br /> Date: 3/l/2022 <br /> A O <br /> r A r'-' - '- l- t I C De5c—r L on of Contenb Regulated Medical Waste <br /> Versailles Salon and Day Spa <br /> •/ � . /'t- Addre,l„ ]010 N Central Ave <br /> City: Tracy <br /> p-` - fbl . . S • ~ CA zip 95376-3915 <br /> " "�• � � - �- �. - Telephone(Rc aired : �. <br /> 9 ) 209-275-9]33 <br /> r <br /> Generator foradcr) Certification <br /> Print Name y <br /> Signature Datc �i_" <br /> • rr _'IIM ' �`' ! ti - 5� COMMFIVTS w,. _ ,M' `• <br /> 6170314001 1GWM-V4-STC <br /> FOR DESTINATION ` <br /> 4 � INATION FACILITY USE ONLY � •• -a f <br /> t 1 �• r i + ' .. f cerrity the contents of this package have been received, treated, and disposed of in accordance with all local, state, and• 1 �..,. • � federal regulatioru. l - . <br /> �_.- rr. • t' Destination Facility: ..- ,s1 � �-. <br /> �i Stericycle, Inc. (CA2) Destination Facill[y' Certification: <br /> Z <br /> I t f \ <br /> 4135 W Swift Ave Print Na rc: <br /> Fresno, CA 93722 Signature: � 4M <br /> 559 275 1121AL <br /> in e <br /> .A�✓� � ! � M ♦, is � ' <br /> IN CASE OF EMERGENCY, OR THE DISCOVERY" OF DAMAGE OR LEAKAGE � \ .�Jb <br /> / , v •' <br /> ` CALL 800-424_y300. CHENITREC CUSTODIER NUMBER 21132 • <br /> 'f. WHITE - RETURN TO GENERATOR YELLOW - SUPPLIER <br /> 4 • r /; • �: 1� PINK - DESTINATION BLUE - GENERATOR '�`� "•` � <br /> , ' <br /> • , <br /> ILiit . ' 1. , • •�� ' - ._ ter_ !-�_' <br /> Sandip Singh, REHS Page 4 of 4 <br />