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I <br /> l <br /> 02/0112017 831-11690012 0001892646 <br /> .f Medical Waste Tracking Document Route No. T07 <br /> Customer: <br /> WILLIAMS FOSTER GROUP LLC 24-Hour Emergency Response (800)424-9300 <br /> 1221 ROSE MARIE LN <br /> Stockton,CA 95247 .Customelr Service (855)508-4)392 <br /> (209)477-2664 <br /> Description of Waste cortalner Type 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 /> 1 1 <br /> Transporter 4: Totals <br /> WM Healthcare Solutions,Inc. Applicable Permits: <br /> 1996 Don Lee Place Ste.C Escondido 568$ MW 172 Phone#; (760)489-5009 <br /> I <br /> Escondido,CA 92029 Vernon-5688-MW-IS7 Phone#; (323)307-0514 <br /> Transporter 1 Ackra®�liyrledgeme�}t of`Rgcsf Materials # <br /> s Print/Typed IVaenae t y f r>�s Uf' Date <br /> 2 - <br /> Signature. <br /> -- <br /> 4L— <br /> Transporter 2:' Permit Date ^ <br /> Address` Signature _ <br /> Printed(Name <br /> I <br /> Autoclave/Tran'sfier Facility Transfer Facility Incineration Facility Incineration Facility AutoCave/Transfer Facility Altemate TreatmenVFadlity ' <br /> Wive Healthcare Solutions,Inc WM Healthcare SoluEtons;inc Curtis Bay Energy Guifwest Waste Solutions, WM Seattle Biomedical -Heatthw;se Services <br /> 4280 aandinl,Blvd 1996 Cion Lee Place Suite C 3200 Hawkins Road GLC 149 SW Kenyon Street 4800 E.Lincoic Av. <br /> Vernon,CA 90058 Escondido,CA 92629 Baltimore,NO 21226 7505 state Hwy 65 Seattle;WA 98108 Fowler,CA 93625 <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#: TS/0ST 81. Permit#:TS-73 Permit#:2012-WMT-0036 Phone(409)267-3913 Permit#:PP0080378 Permit#:TS-89 <br /> Permit#:2239-A <br /> Signature Signature _ Signature Signature Signature _ Signature _ <br /> Dake 10aba J Date Date Date <br /> Discrepancy `freatrnent Facility Certification of Receipt and Destruction' <br /> "I certify'that the contents of the listed containers)have been received,treated,and <br /> disposed of at one or mare of the facilities indicated above in accordance with ail'loc al,state, <br /> and federal regulations. <br /> Comments I <br /> i <br /> 1 <br /> i <br /> Generator's certification:'I hereby declare that the contents of this consignmentare fatly and accurately described above by the proper shipping name and are classified,packaged, <br /> marked and labeled/placardedi and are in all respects in proper condition for transport by highway according to applicable international and national government regulations,including <br /> applicable state regulations'." <br /> 6 ! <br /> Signature „ Print/Typed Name � � Bate ` {{ <br /> I, <br /> 1 <br /> i <br /> i <br />