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04/057 831 115�300i2 OOiJ'1$92ti55 <br /> .. <br /> Medical Waste,:Tracking.Document itait+e htq :x'07 <br /> -11(6rJeA8�'8`E;ttUii1A➢Vt4C3k�14HE!!6'!'- <br /> Custanie3': <br /> GLC7R CHATEAU ( )424-9360 <br /> 1221 Cxt N1 .M <br /> Stockton,CA95267Gu�r t (�5f3 2 <br /> .8- <br /> i <br /> (209)477-2664 <br /> �;Dssta�ner.. �It�::of icor <br /> D r 9fion of l Std Co.riWnere VdIlUtne <br /> UN329.1,R gulated:Medical Waste,KQ S.,6r2',•PGTI Medici Wa (Nd'U)43�,gaf 7 1 <br /> TransoorEer i; <br /> Taptai� <br /> WM Heatt#ic s:;So O ions, Ap ra a F�frfilLS i <br /> 1996 Dori Lee Place Ste.C. E�oatdid5688-MW-.t,n Phone#: (760)189-5009 <br /> Escohdfda,CA 92029, V&noi(a* 8-MW-157 'Phone t: (323)3070514 <br /> Frartisporter'i At [--,d, of ceip�u3f')�iaterYaTs <br /> Si nature Prir>t/fyped,Name u " /�l r: �'F: Mt. <br /> - <br /> r a�. <br /> 7 <br /> / Pmt Date <br /> 10nFtG -- <br /> Addr2s� *natrst'e <br /> jPrintiad Name { <br /> Autbclave(Trafir er PadlitY Trans*Vacilky pdi ei tion�aality PstodseraCktu#Facili y kutrxlavefl nsir�EadlSt} A#t mate Treatmetit.�acility <br /> WM l-1eabuare..5olutilwis,la WMlieaVICOte So)ution5f f� CarlttS�ayEnergy gW.Westwaste Solutions, yyM Seattii.BlomeQic21'. Heaithwise Services <br /> 4280'i1aWHWBIIys! 5996 RgR We Pace Suite C �2w—Humins Ro3d', LLL; 149 SW Kenyon Street 4800,,E,,Llneolc Av. <br /> yemon CA 90058, EStYrndfda,CA 92&29; fI%Itimore,MD 21226 7,50 5. .Kivy 65 Seattle,WA•98108 Fowler,CA 93625 <br /> Phone(559):834-3333 <br /> Phone('323),307-0514 Phone(760)489-5009 J?6one(416),194-3228 3lhahOt TX 77514 Phone(206)565 4063 <br /> Permit#: TS/OS7r:81 Permit#:TS-13 Permit#:.2011-WMi436 Phone(409)2674913 Permit#;PR0090378: Permit#:TS-89 <br /> Permit#;2239-A <br /> Sigma£rase SRgndture SYgnatit3Ye S gsiatun=' Signature.. Signature: <br /> -Rate 1 Dke i3at�: 37aCe Date Date <br /> Discrepancy S Yre tFaC Tfty3we€hYfcat9oh i�f'ReC� mid Dests++fctictn <br /> 1 "T co <br /> cert$y that the ntents of the listed 66ntainer(s)-have been received,treated;oral <br /> disposed of at or more of the faCHId indicated above'in accordance withall local,state, <br /> and, deratregulations:" <br /> Comments.. <br /> ratar'a m°R t erel y deC3are iha>the Contet>t$of)tris cons[griii? a name and are:classT d,Packaged, <br /> ane, Ceat�f� Brit are.flilly'andc#Iratetl crSbed above-by S5Y fh p�at ±r shipp'ng <br /> marfaed mid facie 1placarded,arxi are;in atl aesp ccs 3n.proper c0trdRion for tTensport by highway accord"€ng to appbcable Utternatbnat and-naabnai government regulations,inciiading <br /> ppiirable state regulahpns' <br /> Signatture ,... ... <br /> _.. t <br />