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{ <br /> 0245/201'7 831-11690012 0001892648 <br /> Medical Waste Tracking Document Route No. T07 <br /> Customer: <br /> GLGTR Ci1ATEAU24-Hoavr Emergency Response ($OO)424-5300 <br /> 1221 ROSE MiAklE LN <br /> Stockton,CA 95207 Customer Service <br /> ($55)508-0392 <br /> (209)47.E-2664 <br /> Description of tittaste Container Type No.of Ib.or,—' <br /> rCoslitainer5 ldolume <br /> UN3291,Regulated Medical Waste, f LO..S.,6.2,PGII 43 GALLON(Regulated.Medical Waste(Bio))43.gal ' <br /> Transporter 3.: - Totals i I <br /> WM Healthcare Solutions,Inc. ApplicaUe Permits; <br /> 1996 Don Lee Place Ste,C Escondido-5688 MW-172 Phone#: (760)4895009 <br /> Escondido,CA 92029 Vernon-5688-MW-157 Phone#: (323)307-0514 <br /> Transporter 4 Ac"wledge/merit ufMeceept of Materials ## <br /> Signature t,r/. / Flint/Typed Name _.J s � , k � � � ` Date <br /> Tratisporter:2 permit# <br /> Date T <br /> AddressT <br /> Signature <br /> Printed Name <br /> Autoclave/Transfer Facility Transfer Facility Incineration FaditIi Incineration Facility AutociavejF transfer Facility Alternate Treatment Facifity <br /> WM Healthcare Solutions,Inc. WM Healthcare Solutions,Inc Curtis Bay Energy Gull Waste Solutions, 'WM Seattle Biomedical Healthwise Services <br /> 4280 Eiandini Blvd 3996 Don Lee Peace Suite C 3200 Hawkins Road LLC 1.49 SW Kenyon Street 4800 E.Uncolc Av. ; <br /> Version;CA 9005.8 Escondido,CA 92029 Baltimore,MD 21226 7505 State Hwy 65 Seattle,WA 98109 Fowler,CA 93625 I <br /> PHone,(323)307-0514 Phone(760}489-5009 Phone(410)354-3228 Anahuac,TX 77514 Phone.(206)505-9063 Phone(559)834-3333 <br /> Permit 9: TS/0ST'61 Permit#;TS-73 Permit#:2D11-WMT-0036 Phone(409)267-3913 Permit#:PR0080378 Permit k;TS-89 <br /> Permit#:2239-A — <br /> Signature. Signature. Signature Signature_ Signature Signature II <br /> Date _ Date Data Date Date Date <br /> Discrepancy Treatment Facllft Certification of Receipt and Destruction <br /> t "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 /> Generator's Certification:"I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name and are classified,packaged, <br /> marked and labelediplacarded,and,are in all respects in proper condition for transport by highway according to applicable international and national government regulations,including <br /> appiicabie state regulations." <br /> Signature f PitintlTyped Mame i✓ Date f f�tf 7 <br /> I <br />