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12/1812018 831-13710001 0002107661 <br /> Medical Waste Tracking Document Route No. TP207 <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, KOS_6-2, PGII 43 GALLON(Regulated Medical Waste(B)O))43,000000 gal <br /> Transporter I- Totals <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 1 Acknowledgement of Rete r, of Materials <br /> Signature <br /> Pirlint/Typed NaMe Date 12- <br /> Transpor J1 Permit# Date <br /> Add!�Os Signature <br /> Printed Name <br /> Autoclave/Transfer FaciliW Transfer Facility Incineration Facility Incineration Facility Alt Treatment Fycj[, R,6c6551ng-rFS <br /> WMHS Vernon WIVIHS Escondido Covanta Energy HEST Services Aernerge RedPak Healthwlse Services <br /> 4280 BandIRI Blvd 1996 Don Lee Place 52SI7lana Blvd SW 1420 40th Street North Services S.C.,LLC 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(2S6)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*:ITS-0203 Phone(760)993-2808 Permit TS-89 <br /> Permit#:TS-73 Permit*:TS/05T.'135 <br /> Signature- Signature- Signature- Signature Signature-,, Signature <br /> Date Date Date bate Date Date- <br /> )iscrepancy Treatment Facility Certification of Receipt and Destruct on <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 /> Senerator'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 Jabeled/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 regulations." <br /> 519nature Print/Typed Name Date <br /> ElYd 'ON M <br />