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_ I <br /> 11 !� <br /> l � <br /> 01/18/2017 831-11690012 0001893298 <br /> Medical Waste'Tracking Document Route No. T07 <br /> Customer., <br /> WILLIAMS FOSTER CROijp LLC 24-Hour IEnlerger�cy Response (800)424-9300 <br /> 1221 ROSE MARIE LN <br /> Stockton,CA 95207 Customer Service (855)508-0392 <br /> (209)477-2664 <br /> Descriptiols of Vllaste 12ontairier Type No.of F 16.or .� <br /> Pharmaceutical Waste,Pharmaceutical Waste 1 i0 GALLON#SHARPS CONTAINER AIivR(PhariYraceutiri Waste)10 gal <br /> C°n -Hers Volersne <br /> Transporter 2: Totals <br /> WM Healthcare Solutions,Inc: Applicable Perrrrits: - <br /> 1996 Don Lee Place Ste.C Escondido-5688:-MW-172 Phone#: (760)489-5009 <br /> Escondido,CA 92029 Vernon-5688 MW-157 Phone#: (323)307-0514 <br /> [Signature <br /> anspgrter 1 A oina3edg7e n t of Recut of Materials <br /> i <br /> g7 <br /> Print/Typed Name ��C > <br /> J. C� 1 Date <br /> Trattspo -- <br /> r�r Permit# [gate <br /> Address Signature V <br /> Printed Name <br /> Autoclave/Transfer i`acijry Transfer Facility Incineration Facility Incineration Facility. Autoctav�aino-, <br /> Facility Alternate Treatment Facility <br /> Y✓FT Healthcare Soiuton$ Inc WM Healthcare Solutlons,1nC Curtis bay Energy Gulfwest Waste Sciutions, WM Seadiea! hiealthwise Serv(ces4280.8andini$Ivd 1996 Don Lee Place Suite C 3200 tiawkinsRoadVernon,CA 90058 Escondido,CA'92029 Balkimore;Md3 21226 LLC 149 SWreet, 14600 E.Lincolc Av. 1 <br /> Phone(323)307-0514 Phone 760 489-5009 7505 Statex 65 Seattle,WA 98108 Fowler,CA 93625 <br /> ( ) Perini (41a)354-32-0 Anahuac,TX 77514 Phone(206)505-9063 Phone(559)834-3333 <br /> Permit#, TS/O51 8X Permit#:TS-73 Permit#:201X WMT 0036 Phone(409)267-3913 Permit#:PR0080376 Permit#:TS-89 <br /> Permit# 2239-A <br /> Signature Signature <br /> DSignature <br /> Date Date D eature —` Signature <br /> ture __ Signature <br /> Date <br /> Date <br /> Discrepancy Treatment Facility Certification of Receipt and Destruction <br /> "I certify that the contents of the listed container($)have been received,treated,and <br /> disposed of at one or more of the facilities indicated above in accordance with al!local,state, <br /> and federal regulations." <br /> Comments <br /> Generator's Certification."I hereby dedare'that•the contents of this consignmentare fully and accurately described above by the proper shipping name and are classified,packaged, <br /> marked and laded/placarded,and are in all respects in proper condition for transport tsyhighway according to applicable International and national government regutatlons,including <br /> applicable state regulations." <br /> Signature il i JPrint/Typed Mame i' "Iz`'7 , i s i •. pate <br /> i <br />