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01%25/2017 831-11690012 <br /> OOOIM645 <br /> Medical Waste Tracking Document <br /> Route No. 707 <br /> Customer. <br /> WILLIAMS FOSTER GROUP LLC <br /> 12211 803E MARIE LN 24-Hour Emergency Response (800)424-9300 <br /> 12 <br /> Stockton,CA 95207 <br /> (209)477-2664 Customer Service (855)508-0392 <br /> Dest�iption ofi Waste C®retainer Typeo,of 99�,or <br /> I NV3291;Regulated Medical Waste,M.O.S.,6.2,PGrI i4' �.._� <br /> Containers 1 �®lame <br /> 3 GALLON(Regulated Medical Waste(Bio))43 gal <br /> Transporter 1: _ f <br /> Tasters <br /> WM Healthcare So4'ufions,Inc. f <br /> 1996 Don Lee Place S�.C Applicabl=Permits: <br /> Escondido,CA 92029 Escondido-5688-MW-1.72 Pine#: (760)48°5?09 <br /> VemOn-.5688 C7 W-157 : (323)307-0514 <br /> Transporter R�leksi le�dgemers of R 1�t'asf>�laterials <br /> Signature. 1 <br /> Print/Typed Nrame 1 ' <br /> — Date <br /> Transpopt r — f <br /> ,address Permit —^� <br /> Gate <br /> Signature <br /> "Printed Nam Ie <br /> A�itocleve/Trantfer Facility Transfer Facility fn dnerat''on Facili r <br /> ty Incineration Facility AutoclaveiFransfer PacilitY Alternate Treatment Facility <br /> Wht Healthcare solutions,Inc NIM Healthcare Solutions,Inc I CrrS gds£t -------—_;__ <br /> 4280 Bandini.Blvd 1995 Don Lee Place I y GulNe'�aste Solutions, WM Seattle Biomedical I Healthy ise Services <br /> Vernon,CA 90058 Suite C 3200 Flawkin5.ltaad LLC <br /> Escgnd do,CA 92024 9alklmore,i�IZ) 21226 149 54V Kenyon Street 48 a .lJncotc Av. <br /> Phone(323)307 0512 Phone{760)40-5009 €Ynone 1410)354.3228 7$05 State Hwy 65 Seattle,WA 98108 Fowler,Gi 93625 <br /> Permit#:. TSJ4ST 81 Permit# T5-73 AnahuacLPho�ne <br /> T77514' Phone(206)505-9063 Ptidr�(559)s3a 3333 <br /> Permit#:2021-W Ni;-0036 267-3913 Permit#:PF0080378 <br /> Signature 39-AI permit#:TS-89signatuure SignatureDate C�af2 -- Sg, _- <br /> Date ---•"-;Signature <br /> Date gate— <br /> Discrepancy <br /> ( Treatment F2oifi,ty fec€a�atsarr of AeGeIpt and Loestruction <br /> i ca"sw//that the-contents o`the listed cOni'alner(s)have been:rec&4ed,treated,and <br /> ps?sosed of at ozae or more of the facilitie Indicated above In accordance with all focai,.StaCe, <br /> --d fGderal relations:" <br /> Comments � I <br /> 1 <br /> f <br /> i <br /> mr e d and s Celeifacafi rd rz ieteby di t8re that tf,e:conteats,c."the Consignment are t%f and accuratey described above by the proper shipping name and are classified,Packaged, <br /> marked and tt reg�l tion ed,and are in all respects in Proper condition for trahgpo Y bye highway aorordinq a li t=it gym, I and national government <br /> reg On <br /> s,incl uding <br /> applicable state regulaCTar� ';,'�� <br /> ✓' <br /> Signature <br /> s Print/Typed Narise��`%'` <br /> ���~" Date l _ _ <br />