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C r. <br /> 02/22/20.17 831-11690012 0001892649 <br /> medical Waste Tracking ocurnent Ratite Na r <br /> visswvse nn eawr.o�e.arua�ss 07 <br /> Customer. <br /> GLCTR CHATEAU 4-Hour Emergency Response (801})424-9300 <br /> 1221 ROSE MARIE LN <br /> Stockton,CA 9S207 ustomer Service: (85S)508-0392 <br /> (209)477.2664 <br /> Description of Waste �ContainerType No.of Ib.or <br /> Containers Volume <br /> UN3291,Regulated Medical Waste,N.O.S.,6.2,PGII 43 GALLON(Regulated Medical Waste(Bio)43 gal �- <br /> Transporter 1: Totals <br /> WM Healthcare.Solutions,Inc. Applicable Permits;. <br /> 1996 Don Lee Place Ste,C Escondido-5688-MW-172 Phone#: (760)489-5009 <br /> Escondido,CA 92029 Vernon-5688-MW-157 <br /> Phone#: (323)307-OS14 { <br /> 'I <br /> Transporter&Ack towiedgement o Receipt of Materials i <br /> Signature �� f ... Print/Typed Name - s Date ' _ { ? <br /> Transporter-:6/ Permit# pate <br /> Address. V` Signature <br /> Printed Name <br /> Autodave/Transfer Facility Transfer Facility Incineration Facility Incineration Facll!4 Autodave/Transfer Facility Alternate Treatment Facility <br /> WM.Healthcare Solutions,Inc WM Healthcare solutions,Inc Curtis Bay Energy Guifwest Waste So ions, WM Seattle Biomedical I Heaitnwise Services <br /> 4280 Bandirii Blvd 1996 Doh Lee Place Suite C 3200 Hawkins Road LLC 149 SW Kenyon Street 4800 E.Lincolc Av. <br /> Vection,CA 90058 Escondido,CA 92029 Baltimore,MD 21226 7505 State Hwy 6 Seattle,WA 98108 Fowler,CA 93625 <br /> Phone(323)307.0514 Phone(760)48975009 Phone(416)354-3228 Anahuac,TX 7751 Phone(206)505-9063 Phone(559)834-3333 <br /> Perms;#; T'S/OST 8i Permit#:TS-13 Permlt#;2011-WMI.Ot)36 Phone(4p9}267-3 13 Permit#;PR0080378 Permit#:TS-89 <br /> Permit*:2239-A <br /> Signature _ Signature Signature Signature Signature _ _ Signature <br /> Date Date 1 Date Date Date Date <br /> Discrepancy Treatment Facility Geo ifkation of Receipt and Destruction <br /> "I certify that the content of the listed container(s)have been received,treated,and <br /> disposed of at one or mor of the facilities indicated above in accordance with all focal,state, <br /> and federal regulations." <br /> comments <br /> Generator's.Certification:"1 hereby declare that-the contents of this consignment are fully and accurately descri d above by the proper shipping name and are classified,packaged, <br /> marked and labeled/placarded,and are in all respects in proper condition fortransport.by highway according to apf icable international and national government regulations,including <br /> applicable state regulations," <br /> Signature Print/Typed Name Date <br />