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02/06/2019 831-13530092 0002169617 <br /> ® Medical Waste Tracking Document <br /> WV^UVE! nn^M^q=WM1r=ff%rr Route No. TR302 <br /> Customers <br /> UNCOLN POST ACUTE 24al-llour,EmergenCY Response (600)424-9300 <br /> 1032 N Lincoln St ' <br /> Stockton,CA 95203-2409 Customer Service (855)308-0392 <br /> Description of Waste Container Type --Wo.of Ib.or. <br /> Containers Volume <br /> UN3291, Regulated Medical Waste, N.O.S,,6.2, PG11 17 GALLON(Regulated Medical Waste(Blo))17.000000 gal <br /> UN3291, Regulated medical Waste, 1\1.0.5., 6.2, PGII 31 GALLON(Regulated Medical Waste(Bio))31.000000 gal <br /> Regulated Medical Waste,N,O.S., 6.2,PGII 43 GALLON(Regulated Medical Waste(Bio))43.000000 gal <br /> Transporter 1: Totals <br /> als <br /> WN Healthcare Solutions,Inc. <br /> 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/Typed Name Date <br /> 1. <br /> Transporter 2.. Parmli# Date <br /> Address Signature <br /> Printed Name <br /> Autoclave ransfer Fadli Incineration Faciltty Incineration Facility Alt Treatment Facility ProcesslULITS <br /> WMHS Vernon WMHS Escondido Covania Energy HESI Services Aemerge RedPak Healthwi-se Services <br /> 4280 Bandlnl Blvd 1996 Don Lee Place S2Si TrIa na Blvd SW 1420 40th Street North Services S.C.,LLC 4800 P.Lincoln Av. <br /> Vernon,CA 90058 Suite C Huntsville,AL 35805 Fargo,ND 59102 9600 E.Avenue Fowler,CA 93625 <br /> Phone(323)30-0514 Escondido,CA 92029 Phone(256)882-1019 Phone(701)282-7373 Hesperia CA,92345 Phone(S59)834-3333 <br /> Permit#: TS/OST 81 Phone(760)489-5009 Per-mit#:709-1104 Permit#;ITS-0203 Phone(760)963-2608 Permit#:TS-89 <br /> Permit#:TS-73 Permit#-.TS/OST 135 <br /> Signature- signature_ Signature- Signature Signature- Signature <br /> Date - Date Date - Date Date - I Date <br /> )iscrepancy 11 reatment Facility Ce canon of Receipt and Destructlion <br /> I certify that the contents of the listed container(s)have been received,created,and <br /> disposed of At one or more of the facilities Indicated above In accordance with all local,state, <br /> and federal regulations." <br /> omments <br /> Generator's Certification-"I hereby declare that the contents of tNs consignment are rullY and accurately described above by the proper shipping name and Are classified,package I <br /> marked and labeled/placarded,and are in all respects in proper condition for transport by highway according to applicable international And national governn;IA regulations,including <br /> applicable stato regulations." <br /> Signature Print/Typed Name Date <br /> 601/61 'd ZS� l 'ON NdSti : � 6lH 'WAV <br />