Laserfiche WebLink
t <br /> 03/01/2017 831 1169p012 0001892650 <br /> Mledical Waste Tracking DocumentRouke Na. T07 <br /> wp�rae�neawiac��evae:w-r <br /> Customer, <br /> ilii R SE MADE LN 24-Hour Emergency Response (800)424-9300 <br /> Stockton,CA 95207 Customer Service (855)508«0392 <br /> (209)477-2664 <br /> Description Cf Waste Container Type No.ofIb.or <br /> Containers Volume <br /> UN3291,Regulated Medical Waste,.N.O.S.,6:2, PGII 43 GALLON(Regulated Medical Waste(Sia))43 gal <br /> Transporter is Totals <br /> WM Healthcare Solutions,Inc. Applicable Permits: <br /> 1996 Don Lee;Place Ste,C. Escondido-5688-MW-172 Phpne#: (760)489-5009 <br /> Escondido,CA 92029 Vemoon-5688-MW-IS7 Phone : (323)307-0514 <br /> Transporter 7,Acicctowledgeanent of eceiptof Materials f <br /> Signature �!._ 'T, - ••_ Print/Typed Name �. � ;. ;ti , c :"r Date <br /> Transpprer 2: - Permit# _ bate <br /> Address Signature <br /> Printed Name <br /> Autoclave/Transfer Fadiity Transfer Facility Incineration Facility Incineration Facility Autoclave/Transfer Fad ity Alternate Treatment Facility <br /> WM Healthcare Solutions,Inc WM Healthcare Solutions,Inc Curtis Bay Energy Guifwest Waste Solutions, WM Seattle Biomedical. Healthwise Services <br /> 4280 Bandlni'Slyd 1996 Don Lee Place Suite C 3200 Hawkins Road LLC 149 SW Kenyon Street 4800 E.Lincolc Av: <br /> Vernon,CA 90058 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(4.10)354-3228 Anahuac;TX 77514 Phone(206)505-9063 Phone(559)834.3333 <br /> Permit : T5/OSr 81 Permit#:TS.73 Permit#:2011-WMI-0036 Phone(409)267-3913 Permit#:PR0080378 Permit#:TS 89 <br /> Permit u:223.9-A <br /> Signature Signature Signature Signature Signature Signature <br /> Date Date Date Date Date Date <br /> Discrepancy 'treatment Facility Certification of Recerpt and Destrucdon <br /> "I certify that the contents of the listed container(s)have been received,treated,and <br /> disposed of at one or more cf the facilities indicated above in accordance with ail local,state, <br /> and federal reacriathns." <br /> Comments <br /> Generator's Certification:I hereby declare that the contents of this consignment are fully and accurate„ly described above by the proper shipping name and are classified,packaged, <br /> rnarked':and labeled/placarded,and are In all respects'in proper condition fortransport by highway according to applicable international and national government regulations,Including <br /> applicable state regulations.” <br /> Signature Print/Typed Name Date _ <br />