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01/15/2019 831-13710001 0002118951 <br /> Medical Waste Tracking Document Route No. TR207 <br /> Customer. <br /> DTH QUAIL LAKE 24-Flour 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 Ib.or <br /> Containers Volume <br /> UN3291, Regulated Medical Waste, N.O.S.,6:2, PGII 43 GALLON(Regulated Medical Waste(Bio))43.000000 gal <br /> Transporter 1, Totals :- <br /> WM Healthcare Solutions,Inc- Applicable P6rmlts: <br /> 1996 Don Lee Place Ste.C Escondido-5688-MW-172 Phone#: (760)469-5009 <br /> Escondido,CA 92029 Vernon-5688-MW-157 Phone#: (323)307-0514 <br /> Transporter 1 Ackne7ledgemegt cf Keceipt of Materials <br /> Signature \4 !� Print/Typed Name t ot= ! Date <br /> TranspogefPermit Date <br /> Address ,. "+ Signature <br /> Printed Name <br /> Autoclave ransfer Facill Transfer Facili Incineration Facility Incineration Eaclllty Alt Treatment Facility Pr6lsin S <br /> WMHS Vernon WMHS Escondido Covanta Energy HESI Services Aemerge RedPak Healthwise Services <br /> 4280 Bandini Blvd 1996 Don Lee Place 5251Trlana Blvd SW 1420 40th Street North Services S.0-,LLC 4800 E.Lincoln Av. <br /> Vernon,CA 90058 Suite C Huntsville,AL 35805 Fargo,ND 56102 9600 E.Avenue Fowler,CA 93625 <br /> Phone(323)3070514 Escondido,CA 9ZO29 Phone(256)882-1019 Phone(701)282-7373 Hesperia CA,92345, Phone(559)834-3333 <br /> Permit#: TS/OST 81 Phone(760)489-5009 Permit#:709-1104 Permit*:rrS-0203 Phone(760)983-2808 Permit#;TS-89 <br /> Permit S;TS-73 Permit#:TS/OST 1135 <br /> SignatureSignature SignatureSignature Signature Signature <br /> Date —. Date Date Date Date Ddte <br /> Ascrepancy Treatment Facility Ce-ritificationo Receipt and Destruction <br /> "I certify that the contents of the listed container(s)have been received,treated,and <br /> disposed of at one or more of the facilities Indicated above in accordance With all local,state, <br /> and federal regulations." <br /> ;omments <br /> Generator's Certiflcatlon:"I 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 /> applicable state regulatlons: <br /> Signature Print/Typed Name Date <br /> 8�0 'd 'ON M UiId Z� l l IlH1/6lOZ/IZ/S�d <br />