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01/15/2019 631-13530092 0002118949 <br /> Ili <br /> Medical Waste Tracking Document <br /> 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)508-0392 <br /> Description of Waste Container Type No.of Ib.or <br /> Containers Volume <br /> UN3291, Regulated Medical Waste, N.O.S., 6-2, PGII 17 GALLON(Regulated Medical Waste(81o)) 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-S., 6.2, 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 1 Acknowledgement6f Receipt of Materials <br /> Signature 7 <br /> Print/Typed Name <br /> Date <br /> Transporter 2-' Permit# <br /> Date <br /> Addreps Signature <br /> Printed Name <br /> Autodave/Transfer Facility TransferFacility Incineration Facill Tnelneration Faslll _-Alt Treatment Facill ProcesgDkT�F <br /> WMHS Vernon WMHS Escondido cov;inta Energy HESI Services Aemerge RadPak Healthwise services <br /> 4280 Bandlnl 131vd 1996 Don Lee Place 5251 Triana Blvd SW 1420 40th Street North Services S.C.,LLC 4800 E.Lincoln Av. <br /> Vernon,CA 90058 Suite C Huntsville,AL 35805 Fargo,ND 58102 9600 E.Avenue Fowler,CA 93625 <br /> Phone(323)307-0514 Escondido,CA 92029 Phone(256)582-1019 Phone(701)282-7373 Hesperia CA,92.345 Phone(559)934-3333 <br /> Permit#: TS/0ST81 Phone(760)489-5009 Permit 4:709-1104 Permit*;75-0203 Phone(760)983-2808 Permit#:TS 89 <br /> Permit#:TS-73 Permit#:TS/QST 135 <br /> Signature- Signature Signature- Signature - Signature- Signature <br /> Date Date Date Date Date Date <br /> iscrepancy Treatment Facility Ce cation of Receipt a an Destruction <br /> "I certify that the content of the listed container(s)have been received,treated,ancl, <br /> disposed of at one or More Of the facilities Indicated above In accordance with all local,state, <br /> and federal regulations," <br /> 'ommLnts <br /> Generator's Certification:"I hereby declare that the contGnts of this consignment are fully and accurately described above by the proper shipping name and are classified,package <br /> miorked and labeled/placarded,and are in all respects in proper condition for transport by highway according to applicable International and national government regulations,including <br /> applicable state regulations." <br /> Sl9nature Print/Typed Name Date <br /> 601/H 'd "N Adqti : E 6[0Z '0 [ '1dV <br />