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IF <br /> l Il <br /> 10/23/2018 831-13530097 0002066524 <br /> Medical Waste Tracking OCU elft Route No. TR207 <br /> Customer, <br /> LINCOLN POST ACM 24-Hour Emergency Response (800)424-9300 <br /> 1032 IN Uncoin St <br /> Stockton,CA 95203-2409 Customer Service (855)503-0392 <br /> ,Description of Waste Container Type No.of lb.or <br /> Containers Volume <br /> UN3291,Regulated Medical Waste,N.O.S.,6.2,PG11 17 GALLON(Regulated Medical waste(Bio))17.000000 gat <br /> UN3291,Regulated Medical Waste,N.O,S,,6.4 IPGR 31 GALLON(Regulated Medical Waste(Blo))31,000000 gal <br /> UN3291,Regulated Medical Waste,N.O.S.,6.2,PGI1 43 GALLON(Regulated Medical Waste(Sia))43.000000 gal <br /> Transporter 1, Totals <br /> WM Healthcare Solutions,Inc. Applicable Permits; <br /> 1996 Don Lee Place Ste.C Escondldo-5688-MW-172 Phone 4: (760)489-5009 <br /> Escondido,CA 92029 Vernon-5688-MVV-157 Phone 0: (323)30-0514 <br /> Transporter 1 Acknovuledg thent of Receipt of Materials <br /> Signature print/Typed amt <br /> s date <br /> Transporter 2° Pe it bate <br /> Address S!®ne re <br /> Printed Name <br /> AS rinSfer Facill Tranger Facility Incingration FadJI!y_—ja;lnent(on raclllAlt Treatment MEI-11K P IngrrFS <br /> WMHS Vernon WMHS Escondido cavanta Energy HFSl Services Aemerge RedPok <br /> 42B0 Bandinj Blvd 1996 Don Lee Place SZ51 TrIana Blvd SW 1420 40th Street North Services S.C-,LLC 000 e.UnColn Av- <br /> Vi rnon,CA 90058 Suite C Huntsville,AL 35805 Fargo,ND 59102 <br /> 1) -0514 e=ndIdo,CA 9ZD29 Phone(256)$62-1019 Phone(701)282-7273 Hesperia r-A,92345 Phone(559)834-3333 <br /> Phone 9600 E.Avenue Fowler,CA 93625 <br /> Permit 9; T5/05T 81 Phone(760)489-5009 Permlt#;709.1104 Permit-#;M-0203 Phone(760)983-2808 p -89 <br /> PerTnit#!75-73 Permit 0:_IS1105T 115 <br /> SIgnatum— SignaWng Signature— Signature Signature— <br /> SI lure <br /> Date Date Date Date Date <br /> [late to <br /> 9r7I i p a n r Y re®trrien Pa City <br /> rt Ca on of Oaipt an OeStruon <br /> 1 certify that the contenri OF Me listed conOlner(s)have been received,treated,and <br /> d8posed of at one or more of the facilities Indlcbted above In accordance with ail local,Itato, <br /> -and federal requIaltions." <br /> :omments OCT 3 0 2018 <br /> VVM Healthcare Solutions <br /> Gelleratot's Ccritification;I hereby declare that the contents 6f this consignment are Pully and accurately described above by the proper Shipping norna and are clas5lfled,pa(;kaq�. <br /> marked and labeled/placarded,ancl are In all respeas In proper condition for Transport by highway according TO applicable international and narlanal government regulations,Inciudinj <br /> applicable nate regulations." <br /> SIgnature Print/Typed Name Date -Z-v-) <br /> 6U/z 'd ZSR[ "N NdL� : � 6[H 'U ') dV <br />