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01/22/2019�. 831-13710001 0002121463 <br /> Medical Waste Tracking Document Route No. TR207 <br /> customer: <br /> DTH QUAIL LAKE 24-Hour Emergency Response (800)424-9300 <br /> 1221 Rosemarie Ln <br /> Stockton,CA 95207-6703 Customer Service (855)508-0392 <br /> (209)477-0271 <br /> Description of Waste Container Type No.of lb.or <br /> Containers Volume <br /> UN3291, Regulated Medical Waste,N.O.S.,6.2,PGIT 43 GALLON(Regulated Medical Waste(Bio))43.000000 gal <br /> Transporter 1, <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 Phone#; (323)307-0514 <br /> Transporter I Ackp"edge rent Receipt of Materials <br /> T -Z, <br /> Signature Print/Typed Name <br /> -�427— Date 7 <br /> Perm It$t Date <br /> Addfessr- Signature <br /> Printed Name <br /> Autoclave/Transfer Facili Tran r Facility Incineration Facllfty Incineration Facility Alt Treatment Facilitv�" Processing/TFS <br /> WIVIHS Vernon WIVIHS Escondido Covanta Energy HESI Services Aennerge RedPak Healthwise Services <br /> �,",4280 sandiril Blvd 1996 Don Lee Place 5251 Tria ng Blvd SW 142040th Street North Services S.C.,LLCI 4800 E.Lincoln Av. <br /> ',Vernon,CA 90058 Suite C Huntsville,AL 35805 Fargo,ND 58102 9600 E.Avenue � Fowler,CA 93625 <br /> Phone(323)307-0514 Escondido,CA 92029 Phone(256)682-1019 Phone(701)282-7373 Hesperia CA,9234$ Phone(559) <br /> Permit#: TS/OST 81 Phone(760)489-5009 Permit#:709-1104 Permit#:1TS-0203 Phone(760)983-2'808 Permit#:TS-89 <br /> Permit#:TS-73 Permit#:TS/OST ill, <br /> Signature— Signature— Signature— Signature Signature— -Signato-re— <br /> Date Date Date Date Date Date <br /> iIscrepancy Treatrnent Facility Certification of Receipt and Destruction <br /> 1 certify that the contents of the listed contalner(s)have been received,treated,and <br /> disposed of at one or more of the radlitles indicated above in accordance with all local,state, <br /> and federal regulations." <br /> ,ornments <br /> ienerator's Certification:1 hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name and are classified,packagE <br /> narked and labeled/placarded,and are in all respects In proper condition for transport by highway according to.applicable international and national government regulations,including <br /> ,pplicable state regulations." <br /> ;Ignature Print/Typed Name Date <br /> LOO 'd 'ON xvj HI/61OUIZ/aH <br />