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12/04/2018831-13530092 0002102631
<br /> Medical Waste Tracking Document Route n®. TRZ07
<br /> AWV=".,%Afixb=0rMWTMV
<br /> Customer-,
<br /> LINCOLN POST ACUTE 24-Hour Erne en Response (SOD)424--9300
<br /> 1032 N Uncoln St
<br /> 5tQckton,CA 95203-2409 Customer Service 503-0392
<br /> Description of Waste
<br /> Container Twe No.of Ib.,Or
<br /> Containers volume
<br /> UN3291,Regulated Medical Waste,N.O.S.,6,2,PGII 17 GALLON(Rl!gufated Medical Waste(Bio))17.000000 gal
<br /> 6Z291,Regulated Medical Waste,0.0,S,,6,2,PGII 31,GALLON(Regulated Medical Waste(Blo)),31.0000oo 9cil
<br /> U IILN31-91 Regulated Medical Waste,N*OS,,6,2,115n
<br /> N3291,Regulated Mad"cal.Waste,N.O.S.,6.2,X51K 43 GALLON(RegulatRd Medcal Waste(51o))43.000000 gal'
<br /> Transporter
<br /> ransporter 1: T I 7k47
<br /> WM Healthcare Solutions,Inc, Applicable Permits;
<br /> 1996 Dan Lee Place Ste.c Escondido-5688-MW-172 Phone (760)489-5009
<br /> Escondido,CA 92029 Vernon-5586-MW-157 Phone 4W-* (323)307-4(514
<br /> Signature PlInt" d Nam® Date
<br /> Transporter 20 Permit 3 Date
<br /> Address Signature
<br /> Prier tedName
<br /> A21LCI®V ransfer Facility Trangr Facility inrjnarag2a.Fatly L_�_ -AJtTMatmenjFa4(LY A�ln
<br /> -WMHS Vernon, WMHS Escondido Covanta EneW HER SerAca Aemeqv RedP k r Healthwtse SeNces
<br /> 4280 Bendiril Blvd 1996 Dan Lee Place 5ZSITdana Blvo SW 1420 40th Street North Servloa5 S.r—,raK
<br /> K
<br /> Vernon,CA 90058 Suite!C Hunt5vTile,AL 35905 Fargo,ND 581(i2 117 LLC 1800 U-Lincoln Av.
<br /> 9600 E.A;Mue fowler,CA 93625
<br /> Phone(373)307-0514 Escondido,CA 92029 Phone(756)882-1019 Phone(701)282-7373 Hesperia CA,22345 Phone(559)934-333
<br /> P 55�_4
<br /> Permit V:.TS/DST 81 Pwe(760)469-9009 Permit el 709-3104 Permit#-.M-MOZI Phone(760)9 arnitt TS-89
<br /> t,9
<br /> 05T
<br /> Permit#:TS-73 Permit B;T5J 1:,
<br /> Signature- Slgnaturo� Signature- sionatura signatiire_ nate
<br /> I Date Date Date Date DOW
<br /> uCreCancyTmaumeot ridnWoo-rillficavon ear pt FndCtwn
<br /> -
<br /> I oerUfy that the contents of the listed mrrtainer(s)have been received,Treated,and
<br /> disposed Of at one Or more of tie fadibes Indlizated above in&000rdancewtth all local,state,
<br /> �*rnrnftnts and federas regulations.'
<br /> DEC 12 7018
<br /> wm Healthcare SOILMOns,
<br /> eneratnesCartific3dorL'T MerabV declare that the contents of this consignment are fully and accurately described above by the proper stipping name and are classIried,packag�
<br /> arked end;,libeledlplacapda and are in all respects In proper condition for transport by highway vomrdlng ID applicable Intarriational and national government reqUititlons,lnrJudlnc
<br /> pplicable state regulatans.'
<br /> lignature Print/Typed Name Date
<br /> 60 11LZ d zH i "N M6102 '01 'A dV
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