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MEDICAL WASTE TRACKING DOCUMENT <br />mu&�® SERVICE DATE: ov�ola91a <br />WASTE MARIA®EMENT ROUTE NO. —' TRUCK NUMBER <br />medwastemm.cofl1 <br />Seq Generator No. 24 -Hour Emergency Response <br />0 1. SUTTER.MACY CQ N� . (800} 424-9300 <br />HOSP TA State Generator's ID No. <br />1420 N.TraW Blvd FGenerator's US EPA ID No. <br />Train, CA 95376-3445 - <br />2c. No of <br />2a. Description of <br />F%E <br />L_ <br />a <br />Medical Waste, N.O.S., 6.2 <br />ao.S.. <br />ReguiatedMedlcalWasle,NA.S., 6 <br />UN 3251. PGII <br />Regulated Medlcat Waste, N.a.S., 6 <br />UN3291, PGII <br />'2b. Container Type <br />SHARPS (Pharmaceutical Waste) 0 gale <br />SHARPS.(Phamlaceutical.Waste) 0 gala <br />SHARPS (PharmaCeutical Waste) 0 gal <br />SHARPS (Pharmaceutical Waste) 0 gal: <br />Transporter 1 Is to check box If this is a through shipment ,I <br />Transporter 1 Address: WM Healthcare Solutions, Inc. <br />1996 Don Lee Place Ste. C <br />Escondido, CA 92029 <br />Transporter 1 Acknowledgement of Receipt of Mater <br />Signature <br />5: Transporter 2 Address: <br />Signature <br />Print ! Typed Name <br />6 <br />TOTALS 911=�> <br />D®CUMEN _ 70000,502197 <br />Volume <br />- <br />Transfer Facility; <br />E <br />i <br />wm Healthcare Solutions, Inc. <br />a <br />-� <br />3670 Enterprise Ave. <br />c <br />Hayward. CA 94545 <br />a m <br />Phone (512) 356.8901 <br />2 <br />Permit #: TS -96 <br />Signature <br />o M <br />o <br />Date <br />I w 8 <br />I. ib. or <br />acility: <br />7f3. Transfer Facility:- <br />Volume WM Healthcare Solutions, Inc. <br />5337 Luce Avenue, BLDG 243G <br />McClellan, CA 95652 <br />Phone (512) 356-89D <br />Permit # TS -98 <br />Signature <br />ate <br />7C. Incineration Facility: <br />Z WMRRRC <br />7505 State Hwy 65 <br />Anahuac, TX 77514 <br />Phone (409) 267-3913 <br />Permit #: MSW 2239-A <br />f <br />7D. Alternate facility: iiI <br />, 1 <br />Applicable permit number/s: Escondido- 5688 – MW -172 <br />Phone #: (760) 489-5009 <br />Vernon- 5688 – MW -157 <br />Phgpe #: (323) 307-0514 <br />Print I Typed Name /�-bll- / ' S Date 116� <br />�E. Destination Facility: <br />Daniels Sharpsmart, Inc. <br />l 4144 E Therese Ave. <br />Fresno, CA 93725 <br />i Phone (559) 834- <br />Permit #: TV <br />Signatur <br />Phone #: { } 7. Treatment Facility Printed Certification of Receipt and Treatment <br />" I certify that the contents of the listed container/s have been received, treated <br />and disposed of In accordance with all local, state, and federal regulations." <br />Print Name' <br />Permit number: <br />Date <br />Discrepancy <br />—� Comments ` <br />til TD terminated New TD # <br />Received & Treated In accordance <br />with 25 TAC Sect. 1.136 at <br />Waste Management RRC, TCE® <br />MSW # 2239 A <br />M01 13 2012 <br />Signature Anis— AhIuF07 Dale <br />, . i _'r <br />