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01/29/2019 831-13530092 0002124509 <br /> AsvE ® Medical Waste Tracking Document <br /> nM.A,&w^C3j=-nfflg!M— Route No. TR207 <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)509-0392 <br /> Description of Waste Container No.of 1b.or <br /> Contmineing volume <br /> UN3291, Regulated Medical Waste, N.O.S., 6.2, PGII 17 GALLON(Regulated Medical Waste(Bio)) 17.000000 gal <br /> UN3291, Regulated Medical Waste, N.O.S., 6.2, PGII 31 GALLON (Regulated Medical Waste(Bio))31.000000 gal <br /> UN3291, Regulated Medical Waste, N.0.5., 6.Z, PGII 43 GALLON(Regulated Medical Waste(Bio)) 43.000000 gal <br /> Transporter 1: 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 Rec6ipt of Materials <br /> Signature Print/Typed Name <br /> Date <br /> Transporter 2: Permit# Date <br /> Address Signature <br /> PrIntedName <br /> Autocl8vejTransfer Facility Transfer Facility incineration Facility Indnerarlon Facility Alt Treatment Facility Pro-cessinQITFS <br /> WMKS Vernon WMHS Escondido Covanta Energy HEST Services Aemerge PedPak Healthwise Services <br /> 4239 Bandini Blvd 1996 Don Lee Place 5251 Thana Blvd SW 1420 40th Street North Services S.C.,LLC 4600 E,Lincoln Av, <br /> Vernon,CA 90058 Suite C Huntsville,AL 35005 Fargo,ND 58102 9600 E.Avenue Fowler,CA 93625 <br /> Phone(323)307-0514 Escondido,CA 92029 Phone(256)882-1019 Phone(701)282-7373 He5pena CA,9234S Phone(559)634-333 <br /> Permit*: TS/OST 81 Phone(760)09-5009 Permit#:709-1104 Permit#:M-0203 Phone(760)963-2808 Permit-#:TS-89 <br /> Permit#:TS-73 Permit#:TS/0,5T 135 <br /> Signature- Signature- Signature- Signature Signature- Signature <br /> L <br /> Gate - Date Date Date Date - Date <br /> )iscrepancyreatment Facility Cen cation 0- - f Receipt Destruction <br /> Ton <br /> "I certify that the contents of the listed containers)have been received,treated,and <br /> disposed of at one or more of the facilities Indicated above In accordance with all local,state, <br /> and federal regulations," <br /> ,ornments <br /> Generator's Certification:"I hereby declare that the contents or this consignment are fully and accurately described above by the proper shipping name and are cla5slfled,packag <br /> marked and labeled/placarded,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations,includin <br /> applicable state regulations," <br /> Signature Print/Typed Name Date <br /> 601/N 'd zS�[ "N AdSti: E 6lH '01 'add <br />