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i I <br /> P <br /> X manifest-000986080.... LTJ <br /> Page 1/1 <br /> SHMP514 SSURE <br /> •"®•""""'°"• 000986080 <br /> 855-9-SHARPS <br /> DATE: 0811212025 <br /> GENERATOR INFORMATION <br /> sintia mejin <br /> its just a poke <br /> 3301 w euclid ave <br /> stockton,CA,US 95294 <br /> DESCRIPTION OF CONTENTS: Regulated Medical Waste WEIGHT:15 lbs <br /> GENERATOR CERTIFICATE <br /> "I certify that this container has been approved for the mailing of regulated medical waste,has been <br /> prepared for mailing in accordance with the directions For that purpose and does not contain excess <br /> liquid or non-mailable material in violabon of applicable Postal Service regulations.I AM AWARE <br /> THAT PULL RESPONSIBILITY RESTS WITH THE GENERATOR(MAILER)PORANY VIOLATION OF <br /> 18 USC 1716 WHICH MAY RESULT FROM PLACING IMPROPERLY PACKAGED ITEMS IN THE MAIL. <br /> I also certify that the contents of this consignment are fully and accurately described above by proper <br /> stopping name and are classified.packed,marked and labeled,and in proper condition for carriage by <br /> air according to the national govemmental regulations." <br /> TRANSPORTER INFORMATION <br /> United States Postal Service <br /> COMMENTS <br /> TO BE COMPLETED BY DISPOSAL SITE ONLY <br /> ----------------------------------------------- <br /> DESTINATION FACILITY <br /> Cyntox of Indiana Treatment Facility <br /> 1013 South Girls School Road <br /> Indianapolis,IN 46231 <br /> PP 49-51 <br /> 1 certifythat the..teats of thiscontainer have bees recefeed,heated,and dh—,dof lu w—daece ith all tical.atah,a ad <br /> federal aeaulattens. <br /> bethnewton .L,r:..a. 08/1212025 <br /> Printed Name Signature Date <br /> IN CASE OF EMERGENCY,OR THE DISCOVERY OF <br /> DAMAGE OR LEAKAGE,CALL 1-877-963-3277 a 500 <br /> Wnff2 GENEA4"fOR YE 1TRANGPOaIER OPSn 11 —1.TG MNL 1110ENERAl9a <br />