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07/31/2018 831-13530092 0002055307 <br /> Medical-Waste TrackingMedical- Document Route No, TR207 <br /> customer: <br /> I-1NCOLN POST ACUTE <br /> 1032 N Lincoln St 24-Flour Emergency Response (800)4249300 <br /> Stockton,CA 95203-2409 <br /> Customer Service (855)50&-0392 <br /> ffDescription of Waste Container Type <br /> No,of Ib.or <br /> gulated Medical Waste,N.0.5,,6,2,PG11 11 GALLON(Regulated Medical Waste(610))17000000Conta(nors VotumC <br /> gulated Medical Waste,N,O.S.,6.Z,PG11 31 GALLON(Regulated Medlcal Waste(Bio))31.000---000 gal <br /> UN3291, Regulated Medical Waste,N.O.S.,6-2,PGA 43 GALLON(Regulated Medical Waste(6io))43,000000 gal <br /> Transporter 1: <br /> Totals <br /> WN1 Healtttcsre Sciudorls,Inc. Applicable Permits. <br /> 1996 Don Lee Place Ste C Escondlda 5688•MW-172 Phone : (760)499 5009 <br /> Escondido,CA 92029 Vem®rv-5688-MW-157 , Phone#: (323)307-0514 <br /> Transporter 1 A Iedq int Ceipt of Materials <br /> ST nature Prirlt/Typed Name // ` <br /> ® Ozr/ Date <br /> Tra nspo _ <br /> Permit{k Date <br /> Addre Signature <br /> Printed Name <br /> Autbelav ransfer Padli Transfer Faelt 1nnnPraelon Pedll U1Ciheratlon Fecili All:Troatment F2cil- proces'n FS <br /> WNIHS Vernon WMHS Escondido Covartta Energy HESI Servlc <br /> 4280 Bendtni Blvd 1996 Don lee Plan= "verge RedPBk/ Heaithwue services <br /> Vernon,CA 90058 Sulte C 52517r?an®-Blvd 5W 1920 90th Sb'P.et Neith Servtce%S.C.,LLa 4800 E.Lincoln Av. <br /> Phone(323)307-0514 ESCondldo,CA 92029 Hun Wgla,Al,3-805 Fargo,ND 50102 ' 9600 E.Avenue i=owter,CA 93625 <br /> Perm2 TS/C»'el Phone do A 920209 Phone(256)881-1019 P)ione(701)262-7373 Hesperia Cq,923 5 Phone(559)834-333 <br /> ( Permit ;7091104 Ptnnit 1Ta 0203 Phone(760)503 808 Pt -8g <br /> ParmR.e.TS-73 ' <br /> Permit V:i5/os.T 5 <br /> 519natureSignature Si netUre <br /> Dace �� ! ® Signature Signatvren <br /> Data Da Ce Dat? <br /> Deily,, <br /> lsatpanq Tr%)dfederal <br /> ® <br /> H Ctrtifieation a eeeip an Dcstruchon <br /> e eontenti of the listed contalner(s)have been recelved,treated,and <br /> ne or mord of the facilities indicated above In a0mrdance with ail local,state, <br /> latlons,- <br /> Omment-- <br /> egerakor's certIfitation'"1 hereby dedare that tet contents of thts consignmeng art fulVyand 6=21:ely described Bbove by the proper shipping nam2 end are ClabSiFled,package <br /> marked and labeledlpleeerQed,and arc In all resp in proper mndltson for transport by highway according ro appli<bble infernutional and national government regulad'Fi d Including <br /> ppficable smte reguladons," <br /> stgnature Yy` rint/Typed Natne cr ��� �( <br /> Date <br /> 60l/lti 'd ZSRl 'ON Wd6ti : � 6l0Z 'Ol 'a V <br />