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04/19`Z4?7 i-1169001,2 /0011192657 <br /> i <br /> ... .,. Medi. l'Waste Trap:[ Qmen : at 07 <br /> Customer: <br /> GLC't`R;CHATEAU 14=Haar EM rgency.ReWn (890)4244300 <br /> 1M.ROSE MARIE LN' <br /> Stockton,CA 952D7 it" t er Ce. <br /> .(2.09)477--2664 <br /> desca ci€waste' 'cotitair ''t"yt�e, Via.it€ [3s:or <br /> Containers Yailuirie <br /> UW2!91 <br /> r Regul ed Metrical�,KQ3 „ S.Z,P U. AL3 6ALtt3,Y(Re, late€s:t+3 dEcai VYaSte> ib))43 ga[ <br /> �6 <br /> Transporter 1, ) 11$Ia15 <br /> wM H64thcare 5cr#utiorst Inc: ApOicpNe Permits: <br /> 1 <br /> OM:Op Lee:Place S .:C Fscandido-.5688-MW-5:72 Pt ggnr#: `k`?£0)489 6 <br /> Es r)r i r ivA 92429 �lpom7 5888.-MW-157 Phone#:. (323)307-05 4 <br /> tt { / " tofMaterialsTns vA <br /> Signatuare Prig'VIYped Name c <br /> - <br /> transRate <br /> parte —---� <br /> Address. Signature <br /> - Printed litattre <br /> Aut T vOrrN ss f.adlit; TrattsferFagil y InC340abon Facility ladner4tIo1=Fadilty Auto JaveltraftsferPecility <br /> Afkemate'Treatmerft Pacifty <br /> wM Heattfpre:5afui ""IM WM N+aetYtlicare soiudons,Inc' Gsuhs Hay ergy 6uffvreg wa,%e5olutlom, wM. attie'SPorriedical( Healftvise Services <br /> 4280 Bandrni BIVd 1.996 Oen tee Plane Suite C' 2IM Hawkins Road ti.0 149 Kenyon Street 4800:E.tincolc Av. <br /> Vemotl;;cA'90058; Escondidp,CA 92029 Baltimore,M0'21226 7505:Stats?:Hwy654 See le,WA 98.108 Fowler,CA 93625 <br /> Phane.(323)307.0514 Phone(760)489.5009 Phone(41.0}359-3228 Anatluae,TX 77514 Rho a(206)505 063 Phone(559)834.3333 <br /> Penn T;€. TS/OST$x Permit f:TS 73: Permrt,#;.201X+WM17606' „.Phone(409)267- 913 Per t#:PR0080379 Permit 7t:TS-89 <br /> Permit*:2239=A <br /> Signature Srtjnature „54yssature Signature sign ure: . . . Sgnature. <br /> Date ate Date Date Date <br /> D screpancjr; Treatment(icwty Ceitrm6tkh of ipt andf tk%ttue" h: <br /> IOM—that the:contents of the listed ntainei(s)have been received,:VOW and, <br /> disposed of atone or more of the facifid s indicated above in accordance with:Eli ioi,state, <br /> and federa7'rege.f4ons" <br /> Comments <br /> Cue. t or'S tq�:"I hereby ti#etlare ttaaG the cdJnteaifs of tfiis,cRniyrsme are fulj and acarsatl�destrii3ed alio ie'by c propi sh gp6±g Warne and are ctassifled,packaged, <br /> marked and iatieled%piacarded;and are.in alitespeets rn proper cbadif4On.for transport by tiigtiwayy t.=-.ting Wapplicable'ihteina ionai and na6orl6l government regulations;Including. <br /> appluabie'state regulations:: <br /> S'sgnatui'e. Rrirej t ypae`. <br />