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M <br /> i <br /> ' i6 <br /> 0111112017 t1"` I 8.31-115 Dk2 001892543 <br /> 6 In c�n.e�-;�� v a4-�,- �slc.�� t,.��t� <br /> rvu4 kLT <br /> Me 'C l ante'Tracking Docu ent ROUte No. T07 <br /> Customer <br /> 1.221 ROS l f ARIE LN C;Rf7t1P LLC 34-)!loam'Emergency Response (800)424-9300 <br /> a 221�ets�MARIE <br /> Stockton,CA.95207 Cu6tonier Service (ass)5os-M2 <br /> (209)477-2564 ' <br /> Ii7&ciptiorl ot"Waste IContainerT�pe No.of I Ib.lar <br /> r ° Ge ntaineng Volt: ! <br /> JUM291,Re-gilated Medical Waste, KO.3.,5.2,!001 43 GALLON(R#908ted Medical Waste(sjo))43 gal <br /> ' 1 <br /> ( <br /> Transporter I: - ---- -f <br /> Tatals ! <br /> WM Nealtttcare Snlutlons,Inc, Applicable Permits: <br /> 1196 tion Lee Place Ste,C Fsmrsdido-5688.-Mw-172 phos,e¢: (760,499-50109 <br /> condii4p,CA 921323 Ve,,-'Dn-5688•MW-157 Phone#: {323;307-0514 <br /> Trartsi2 atter I A fedgem6 a€ ipt .atesiais <br /> i�9rratur;ss d /� , <br /> PrInt}Typed Name (4S a Date <br /> !strait# DTra<Et <br /> Printed Name <br /> kt tc favArtrarrsFer Fzcilky Tmhsfer aciltty yneneration Pa lhtyIncnera}ion FacAlty ,A€ted?ve/1'ransfer racill <br /> l itY i A#temate Treat+-•ent racitltq <br /> 4Vh F#ealt`1c su iudons,fn-- l AN 9ea?;13C3 e rwut y' _ 35'i3�;9; . - _ <br /> au .-na rrr nlw 599u 0�Lee Place St,#te G z5 3200 Hv*j Road Guif est Yas;e Soii;tior•.s, f V41[:ztile 8,o4rzdicai f flealthwise Serves <br /> s Ve^ton,CA 90058 (Escondido CA 92D29 LLC 49 8W Kenyw Street !48pi3 E Liar lc Av. <br /> r 6alt€rrlore,P fi:} 21226 7,fiS aha" tfwy&5 Seattle,WA 98103 FOWkr,CA X33625 <br /> Pflorte j323;307 05-04 f t�tsxte(AS0)489-5009 Phone 41,01,35-1-3228 <br /> Perrnrt ; 31 ( Anehua4 TX 77514 I Phone 206 <br /> —x' i P sot :75 73 Nr:trit*!2011-WMS-0036 I <br /> Phone(409)267-3913 + Permit#:PROO903 83 !Pamir#Phane 55834:.31 33 <br /> i Perm?,0:2239-A � <br /> i SIQRa'C'f z I-. [ <br /> !1 —-- -- Srgrcatl r;_ 1SI ttrP, ( S 1 <br /> e!e #^sate iSSri3tvre j5#gr�ature (Signature �� # <br /> ---- date i7a e _ Date <br /> DISCr£gd�r TP�9irrfErS'r;�dCi TertifiCaVori of Redeij*aril$Dest.i6C.tior. <br /> tell; y t:tat L conientsof the listed containe(s)have been^tceived,treabed,and x <br /> disposed of at one or more of the'fac#I#t es iridj cated above in actor a,sce with a?#1ct ai,state. <br /> and federal regulators" s <br /> } <br /> i <br /> Gearorator s Cerufrt altroq "I fier oy.devare that the conter7t$of blis 00nSITIMena are fu5y and accureeiy deserlbed above by the proper shipping name and are classified, <br /> marked and labeted(pta ded,and are in aff rmspetts i»paper condition fpr trai b h°^huaa acCorci#,i o a, flcah#e#r3#ePndtianal and na;ianal a+rme and <br /> r packaged, <br /> applicable state regui�ons.' / y. Y 9 aP g egu'.a`iims,inducting <br /> Signa e Q oz `�" Prion/Typed Name r`—� <br /> -- �--�� ___ a it <br />