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i <br /> i <br /> 08/1$/2016 831-7310001 0001603614 . <br /> I <br /> Medical haste Traeldng Document Route No_ Tit? <br /> Customer: <br /> 24-Flour Emergency Response (800)424-9300 <br /> customer Service (8575)308-4392 <br /> i <br /> - .No.of ib.or <br /> j Desciption of Waste Container Type j Containers Volume <br /> UN3291,Reguiated Medical Waste,N 0.5:,6.2,PGII. O-FHER(Regulated Medical Waste(B!o))0 CY <br /> Totals �'��'f <br /> 1 Transporter 1.: .•'aa"' .+wP <br /> WIM.Healthcare Solutions,Inc. Applicable Pennits: <br /> 410 East Grant Une.RoadEsmndldo Sb88-'MN,172 Phone : (760)?89 5009 <br /> Tracy,CA 95376 Vernon-5688-MW-157 Phone a`: (323)307-0514 <br /> I Transporter 1 Ac( wl <br /> moedgement of Recdipt of Materials § . <br /> j §ignatve PrAii7yped name i ! r. a t/:A Date <br /> ! 7 <br /> PeI'n2i:# - <br /> AddressSignatune <br /> Printed Name <br /> i AutodaveFransferFad ity Transfer Faclhty _ - Incineration Facility .. Inaneration Facirt Autodaveli'ransfer Fa&4 'Alternate Treatment Facility <br /> WM.Hea!tkrpre Solutions,Inc WIN!Healthf2 e Solutions,Inc G rtis Say Energy G-elfvtest Waste Solutions,. WM Seattle B omedical Heplthwise Services <br /> 42W Bandmi Btvd 1996 Don Lee Piece suite C 3200 HavWdns'Road LLC 149 SW Kenyon Street 4800 E.Linmlc Av. <br /> j Vencor:,CA 90058 Escondido,CA 42029 Baltimore,KD'21226 75 35 state Hwy 65 Seati+e,WA 98208 'royv�r CA 93625 <br /> Phone(323)307-0514 Phone(760)'489'-5009 Phone{410)354 3228 Anahuac,TX 77524 Phone(206)SOS-9063 Phone(559)834-3333 <br /> Permit#r: TS(D67 81. Permit#:TS•73 Permit#:2011-WM:-0036 Phone(409)267-3913 Permit#:PRMS0378 Permit TS-89 <br /> Permit r:2239-A <br /> 9 <br /> Signature natvre Etlsrgnature Signature signature Signature <br /> Date 1 Date Dam Date <br /> Date. !EDate I <br /> Di—paticy.. Treatment Facility rCerb'fication of Receipt,and Destrucdgn - <br /> "I certify that the contents of the listed Containers)have been received,treated,and <br /> disposed of at one or more of the facilities indicated above in accordance.with ail local, ! <br /> stats,and federal regulations." <br /> Comments' („ <br /> C-eneraWr's CeMffctUdn:"I hereby declare Uiat rile contents of this consignment raw fully and accurately described above by the proper shipping name and are classified,pad(aged, <br /> madced and iabeloplacarded,and ate in all respects in proper condition for tnansport by highway accor fng to applicable interna l)na!and national government regulations;indaMng <br /> apoticable state reguk-ft S." <br /> Sigaiature -"Print/Typed Name <br /> Date <br />