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132(22/2017 SM-11690012 11001906281 <br /> medical Waste Tracking Document Route No. TO, 7 <br /> Customer: II <br /> i5LCTP CHATEAU 24-Hour Emergency Response (800)42479300 <br /> 1221 ROSE,MARTS N <br /> Stockton,CA.95207 Cusfi nf&SeMii a (855)508-0392 <br /> (209)477-2664 <br /> Descript"lon.of Waste c€rntainerType: NO,of I lb.or <br /> Containers ': Volume <br /> PharmaceiiYltai Waste,Phwmace>:bcal Waste ho' LLON SHARPS CONTAINER Tharrrracepli.cal Waste)10 gal <br /> I 'Totals # <br /> Transporter 1. <br /> WM'Healthcare Soiulions,Inc. Appritabie O?Mits- <br /> 1996 Don Lee Place Ste.eEscondido-5688-MW-172 Phone (760)489-5049 <br /> Escondido,.CA 92029 Vernon-5688-MW457 Phorre (323)3470514 <br /> Transport+er..i A4rf6Wtedgen,e of 'pt of rRatP-ftls <br /> Signature i, -�` Pdrt/T d Name. ! -° c Dam !; <br /> Trans Permit Vie: <br /> Address Sinr <br /> PrIniten r+10010 <br /> Autoclave%TransFerFadiity Transfer Facility Ineltieratlon f ii€tj incineration Fddiity Autoclave,F'raoster F.acaky 'iltemate Treatiment Facility <br /> INM Healthcare.Solutions,Inc WM HealhcareSatutions,Inc Curtis Say Energy GOAMS,waste Solutions, WM Seattle Biomedical Heaithwise Service; <br /> 4280 Bandini Blvd 1996 Don Tree Paace.Suite C NO H..wwkim glad LLC 149 SW.Kenyon Street 4800 E.Uncolc Av. <br /> Vernon,CA 90058 Escondido,CA 92029 304drriore,Mia 21 6 7545 State Hvq 65. Seattle,.WA 98108 Fowfer,CA 93625 <br /> 051 <br /> Phone(323)307- 4 Phone(760)4$9-5009 phone(410 )354-3228 Anahivac,TX 77514 Phone(206)505-9063 Phone(559)834-3333 <br /> Permit#: TS/OST'81 Permit:#:I5-73 iC#:2011-WPEI-� Phone(409)267-3913 Permit:#:'PR0080378 Permit#:TS-89 <br /> Permit#:22394 <br /> Signature, Signature. Signature... . . ... Signature ;Signature Signature <br /> Date Date Da Pate Date Date <br /> Discrepancy Certification,of Destruction <br /> "I certify that the contents of the listed contalne(s)nave been received,treated,and <br /> disposed of at one or more of the,tdiltles Indicated above in accordance with all local,State, <br /> i and federal regulatlom <br /> comments <br /> Generator's Gertifii atiah.°I hereby.4eclare that the cbritents of tWonAsignmert.are Wily and accurately desc(tecl above by the proal chipping name and are da5sfed,packaged, <br /> marked and:labeled/placarded,,and are'in all respects in ptdper condition for tramport by highway accosting to 3pplicable'In[e6natlonal'and natidr^.ai government regulations,;including <br /> applicable state'regulations." <br /> t <br /> Signature' ; , prirtfTyped Pdame <br />