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03,x15/2017 831-11696012 0001892652 <br /> Medical Waste Tracking Document Route No. T07 <br /> wrer:e,•�wr�f�w.o.wsa��eae.�euir <br /> Customer: <br /> GLCI'R CHATEAU 24-Hour Emergency Response (800)424-9300 <br /> 1221 ROSE MARIE LN <br /> Stockton,CA 95207 Customer Service (855)508-4392 <br /> (209)477-2664 <br /> l>escription of Waste Container Type No.of � ib;or <br /> Containers Volume <br /> UPW91;Regulated Medical Waste,N.O.S.,5.2,PGII 43,GALLQN(Regulated Medical Waste(Bio))43 gal -^ <br /> I <br /> Transporter 1: Totals t <br /> WM Healthcare Solutions,Inc. Applicable.Permits: <br /> 1996 Don Lee Place Ste,C Escondido-5688-MW-172 Phone (7.60)489-5009 <br /> Escondido,CA 92029 Vernon-5688-MW=-157 Phone: (323)307-0514 <br /> po g ptofmateria ls <br /> SignaturePrint/Typed <br /> s x„ <br /> Trans rter 1 Acicnowled einenit o'l; <br /> rPrint/Typed-blame � � e�- s; � 7Date � <br /> T'ransporl:4i- Permit# Date <br /> Address' Signature <br /> Printed Name <br /> Autodave/Transfer Facility TtansFer:Faci3ity incineration Facility Incineration Facility Autociave(Transfer Facility Alternate Treatment Facility <br /> WM healthcare Solutions,tnc I WM Healthcare Solutior>.s,Inc Curtis BayEnergy Guftwst m <br /> Waste Solutions, WM Seattie.Sioedical Healthwise Services <br /> 4.280 Sandini Blvd 1996 Don Lee.Place Suite C 3200 Hawkins(toad LLC 149 5W Kenyon Street 4800 E.Lincoic Av. <br /> Vernon,CA 90458 Escondido;CA 92029 Baltimore,MD 21226 7505 State Hwy 65 Seattle,WA 98108 Fowler,CA 93625 <br /> Phone(323)307-0514 Phone(760)489.5009 Phone(410)334-3228 Anahuac,TX;77514 Phone(206)50S-908 Phone(559)834-3333 <br /> Permit ol: TS/OST 81 Permit#:TS-73 Perritt#:2011-WMI-0036 Phone(409)267-3913 Permit#:PRO980378 Permit#:TS-89 <br /> Permit#s 2239-A <br /> SignatureSignature Signature Signature Signature Signature <br /> Date Date Date Hate Date Date <br /> Discrepancy Treatment FacH t r Certification of Receipt and Destruction <br /> "I certify that the contents of the listed container(s)have been received,treated,and <br /> disposed of at one or more of the facilities indicated above in accordance with all local,state, <br /> and federal regulations." . <br /> Comments <br /> Generawes'Certffication:"I hereby declare Haat the.contents ofthis consignment are fully and accurately described above by the proper!shipping name and are classified,packaged, <br /> marked and labeled/placarded;and are In respects In proper condition for transport by highway according to applicable International and national government reguiabons,including <br /> applicable state regulations." <br /> Signature, Print/Typed Maine Gate <br />