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01/03312029 1111,137110111 0002115986 <br /> Medical Waste Tracking Document <br /> wry t14me6alEgacee�: Routelhle� 1R207. <br /> customer. <br /> DTH QUAIL LAKE 24-Froth Einergioncy:Response (901D)424-9300 <br /> MI Rosemarie Ln <br /> SWC!06,CA 45207-5703 Cuswm.ar Stirvice (855)509-630 <br /> (209)477-0271 <br /> Description of Waste Cont3iinerType N%of Ib.ar <br /> Containers Volume <br /> UN3291,Regulated Medical waste,N.O.S.,6.2;PGII 4.3 GALLON(Regulated M6dic6l Waste(Bio))43.00900,gai <br /> - <br /> Transporter 1: Totals <br /> WW HeaidrAreSbluVons,Inc. <br /> 1.996 Don Lm PJxe Ste.C ESCondido-.5688-MW-172 Phone (760)q89-5009 <br /> Escondido,CA 92029 VeT:non-56"-MW 157 Phone (323 307-,0514 <br /> Transporter 1:Acknom.deftement of-P, of Materials <br /> Print/Typeo Ham Date > <br /> Transporter 2-t, <br /> pennit 0 <br /> Address..."', Signature <br /> PrIated NaMe <br /> LAWRnclaransfer Fadftry <br /> Incineration FadlML_' Art Re2"ent Facility <br /> WMHS Vemon wm195 Escorldldp Coyao,4 Energy IIEST S&V1res; Aemepge RedPak tica-khwise Services <br /> 4280 5andini Blvd 1996 Don�ee Place. 5MTriana Blvd SW 1420 40th Street North Services 5,C,,LLC E.Lincoln Av- <br /> AL Vbf 4800 E: c <br /> Vernon,CA 90058 Suite C. Hur"lle, Fargo,Nb,58A:Z 9600 E.Avenve Fowler,CA 93625 <br /> Phope(3Z3)3070514 Escondido,CA 92029 Phone(256)832-1619 Phone(701)'42-V73 Hesperia tA,92.R5 Phone(559)934-3333 <br /> Permit 0! T5/05T 81 Phone(760)484-5009 Pert*#'.109-1104 PeMli:*;ITS-,02113 Phone 7150)983-240 Permit#:TS,,89 <br /> Permit#,TS-73 Pfnnit#7 TSIOST 13$ <br /> Signature Signat6m- signature, <br /> Date Date Date Date Date Data . <br /> A <br /> xEcreparicy rot FaaFtV:c6Mfkarwn cW <br /> I certify ttiat:ihecontents of the 0sW goatalner(s)have been received,treatedr and <br /> d.lsposoA of at one or more of the feicintles lijoicateti above in accordance Mth 811 local,-tate, <br /> and federal Milmocr—, <br /> .omments <br /> Ge narator's Ceftificarkion.Theret7j d&Jare zhEk the Corti of this consignment are fully and acclirately described above;by the pyopershlplAog nafm and arQ claWftd,pada <br /> marked and la-be,le.dffilacaWed,and&e in A respects 10 proper.condition for tramOort W h1oh,�,ay.accordirkig to 9ppli0able i0ernatippa.I and net*bl.�ovemment regulations, <br /> indudinc <br /> a.pplicabte state reoulations.'! <br /> S <br /> 'mature Prhyt/TyP,W 4Name Lit, r L. Date <br /> 800 'j 'ON M <br />