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02/20/2019 831-13530092 0002169634 <br /> ®ASY� Aa <br /> Medical Waste Tracking t Route No. TR301 <br /> om emu-&- <br /> Documen <br /> customer: <br /> LINCOLN POST ACUTE 24-Hour Emergency Response (800)424-9300 <br /> 1032 N Lincoln St <br /> Stockton, CA 95203-2409 Customer Service (855)508-0392 <br /> Description of Waste Container Type No.of Ib,or <br /> — GALLON UN3291, Regulated Medical Waste, N.O.S,,6.2, PGII i7 (Regulated Medical W­aste(Blo))�17.00�0000 gal <br /> UN3291, Regulated Medical Waste, N.0-S.,6.2, PG11 31 GALLON(Regulated Medical Waste(Bio))�31000000 gal <br /> UN3291, Regulated Medical Waste, N.O.S.,6.2, PGR 43 GALLON (Regulated Medical Waste(Bio))43.000000 gal <br /> Transporter IL: Totals <br /> WM Healthcare Solutions, Inc. Applicable Permits: <br /> 1996 Don Lee Place Ste,C Escondido-5688-MW-172 Phone#: (760)489-5009 <br /> Escondido,CA 92029 Vernon-5688- MW-157 Phone#: (323)307-0514 <br /> Transporter I Acknowledgement.of Receipt of Materials <br /> Signature <br /> Print/ ped Name Date <br /> Transponeo 2:", Permit# Date <br /> Address Signature <br /> Printed Name <br /> Autoclave/Transfar Facil Transfer Facillpi Transfer Facility Incineration Facility Incineration FalcillSy Alt Treatment Facility <br /> WMMS Vernon <br /> WMHS Escondido WM LODI Covanta Energy HEST Services Aemerge RedPak Healthwise Servicei' <br /> ,9280 Bandini Blvd 1996 Don Lee Place 1333 E.Turner Rd 5251 Triana Blvd SW 1420 40th Street North Services <br /> _es S'C.'LLC 4800 E.Lincoln Av. <br /> Vernon,CA 90058 Suite C Lodi, CA 952410 Hum5vllle,AL 35805 Fargo,ND 58102 9600 E.Avenue Fowler,CA 93625 <br /> Phone(323)307-0514 Escondido,CA 92029 Permit*:T/S 34 Phone(Z.56)882-1019 Phone(701)282-7373 Hesperia CA,92345 Phone(559)834-3333 <br /> Permit#; TS/OST 81 Phone(760)48:9-5009 Permit#:709-1104 Permit#:ITS-0203 Phone(760)983-2668 Permit*:TS-89 <br /> Permit#:TS-73 Permit#:TS/OST 135 <br /> Signature— Signature— Signature SlgnAturc— Signature Signature— SlgnaWr <br /> Date Date Date Date Date Date Date <br /> Discrepancy Treatment Facility Certification of Recelpt and Destruction <br /> 1.1 certify that the contents of the listed container(s)have been received,treated,and <br /> disposed of at one or more of the facilites indicated above in accordance with all local,state, <br /> and federal regulations." <br /> Comments <br /> Gentratoes Certification:"I hereby declare that The contents of this consignment are fully and accurately described above by the proper shipping name and are classified, <br /> packaged,marked and labeled/placarded,and are In all respects in proper condition for transport by highway according to applicable international and national government <br /> regulations,including Applicable state regulations." <br /> Signature Print/Typed Name Date <br /> 60Li 'd zS� [ "N NdSti : � 6lR '0l ,AV <br />