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831-13530092 0002084488 <br /> Medical Waste Tracidng' Document Route No. TR207 <br /> customer <br /> LINCOLN P057 ACM 24-"our Emergency Response (800)424-9,300 <br /> 103Z N Lincoln St <br /> Stock n,CA 95203-21109 Customer Service (855)508-0392 <br /> Description of Waste Container Type No.of ib,or <br /> volume <br /> .UN3291,Regulated Medical Wasmr N.O,S,6.2,PC511 17 GALLON(ReqUated Medical Waste(Bro))—17.000000 gal <br /> UN3291,Regulated Medical Weser,N.O.S.,6.2,PGI1 31 GALLON(Regulated Medical Waste(B10))31.000000 gal <br /> UN3291,Regulated Medical Waste,N.O.S.. 6.2, PGII 43 GALLON(Regulated Medical Waste(Bfo))43.000000 gal <br /> Transporter I- Totals <br /> WM Healthcare Sclulion5,Inc Applicable Permits; <br /> 1996 Don Lee Place Ste,C Eswndido,-5688-MW-172 Phone#; (760)483-5009 <br /> Escondido,CA 92029 Vernon-5688-MW-157 Phone t. (323)307-0514. <br /> Transporter MMntVf-fb=ejPt.of Materials <br /> Signature % I Dube TO &7q,3 <br /> Prinped ame t/TyNTnGMPz--LL- - 4 <br /> Transporter 2: Pon-nit Daft <br /> Ad&ess Signature <br /> Printed Name <br /> 4today M2ager Facnz Incineragm Fa I YnUn Fabpn Fad <br /> A"T n-,Fag P -narl-Fs <br /> nMF <br /> tme <br /> WMMS Vernon WMHS acand1do Covanta Energy HESZ Services A6meqe ftedPak Heattlivilse <br /> 4280 llandlri[Blvd 1996 Don Lee Place 5251 Trialia aNd Sw A® <br /> in�S.0 <br /> 1420 40th$"K North Services S.C, 4800 E.Uncoin Av. <br /> Vernon,CA 90058 suite C Hunt5vllle,At 35805 Fargo,ND 58IO2 9600 E.Avenue Fowler,CA 93VS <br /> Phone(323)307-0514 Escondido,CA 92029 Phone(256)882-1019 Phone(793.)ZBZ-7373 haspari�l 92 Phone(S59)934-3333 <br /> 1� 0�9 3 <br /> Permit*. TB/091rel Phone(760 4ag-soo9 Permit 9:709-1104 Perylit#;US-0203 Phone(79)92833- 08 0qjjjt;0:T5-89 <br /> Purrilt#:TS-73 e it 41 �/()S_r I <br /> SighAtum- Stgnaturg- Permit 4:'Mj0ST A <br /> Slariature— Signature Signature lure <br /> L Date - Date 't�t <br /> ')Otk� —, . I Date EDAte Date <br /> xscreparicy wreatd I MY ZeRmallUt-t or R rptandoestruction <br /> "I OerbN that the contents of the It cont3lner(s)have been received,heated,and <br /> disposed of at one or more of the ftidlites in-jicated above in accordance with all IMI,state, <br /> -and ruderal regulations." <br /> ornmQnffi <br /> OCT 3 0 2018 <br /> WM Healthcare SOlutlons <br /> Generator's Certification;"I hareby declare that the cnnteilu Of tills consignment are fully and accuratdydeKribed above by the Proper shipping name and are classified,packag <br /> narkerlend labeled/placortled,and are inail rwpectsln PropercDhelltion NrtrarqmrtbyhlgMwaiyaccDrdlngtoapDlkable)nlmmaUonaland national gOvemmentrequiations,lndudfn <br /> appkable smote regulations." <br /> Signature wl Prin"Ped Name GIA. tan"' Date G�db�61 <br /> to <br /> 601/�� d zH [ "N Nd« : � 6 �H 'U 'add <br />