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Manifest lD <br /> 5 <br /> r� Stericycle" 4480224 <br /> • Protecting People.Reducing Risk,' III I I I III'I III�III�IIII�II�IIIIIII <br /> WASTE TRACKING DOCLINIEN f—MAN IFI.S'I' <br /> 1. Ensure the injarntnlian in.tiertionn/r�r rorrcct and annplelr <br /> 2. Print,sign,and dale Section 2e <br /> 3. Keep the bottom(blue)copy jor your records <br /> 4. Sea/this farm in the zipper bag on the oulcidc njrhe return bus <br /> "t certify that this container has hcxn n Geocnt n(Mni1eH Certi(iculion <br /> "I rtify ppr(,ed f r it',acting 1,vgulaml nKi el Made r sharps w t re( noted txluw), <br /> Prepared for..wiling in accordance aith Ibe dncc(>ns frr that I—pos,and does not a rla n xcess liquid or <br /> rammailahte nuterial in siolation of 11. apPlicable Postal Service r bukdion.. I AM AW iRI: THAT FULL <br /> RESPONSIBILITY RESTS WITH THE GENERATOR(MAILER)FOR ANY VIOIATION OF is USC 1716 WHICH <br /> MAY RESULT FROM PLACING IMPROPERLY PACKAGED ITEMS IN'1111,MAIL.I also certify that the comcnis o1' <br /> this consignment are fully and accurately dcacribcd above by proper shipping nano and me classified,packed,n rked.and <br /> labeled.and in proper condition for carriage by air according to the national govermirntal regulations:' <br /> Dater 81312023 Sharps Waste <br /> Description of Contents: <br /> L C merator(Matter)Information <br /> Nam: NICOLE BARBER <br /> Address: 211 E.MARCH LANE STE C <br /> City: STOCKTON State: CA rip 95207 <br /> Telephone(Required): 209-326-4224 <br /> r)Certification <br /> Print Name Signature Date <br /> to <br /> 7 COMMENDS <br /> 35514 REPUBLICSHARPS IQ-V3-REPA <br /> FOR DESTINATION FACILITY USE ONLY <br /> eer*'tb aconteWs of this package have been received,treated,and disposed of in accordance with all local,state,and <br /> x i$"ticiat regidaliorts. <br /> Facility. Destination Facility Certificutiom <br /> .Y 1 Inc.(CA3) Print Narm:_ <br /> .�t.,'.R A BRIDGEFORD ST Signature: <br /> A 95206 <br /> Date: <br /> 1�3yCAS1,OF EMERGENCY,OR THE DISCOVERY OF DAMAGE OR LEAKAGE, <br /> a l CAU$00.424-9_m.CHEMTREC CUSTOMER NUMBER 21132 <br /> WHITE—RETURN TO GENERATOR YELLOW—SUPPUER <br /> PINK—DESTINATION BLUE—GENERATOR <br />