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12/11/2018 831-13710001 0002105071 <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 Ib.or <br /> Containers Volume <br /> UN3291, Regulated Medical Waste,N.O.S., 6.2, PGR GA6t9N•(Regulated Medical Waste(Bio))-49, <br /> Transporter 1: Totals 9 <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 Receipt of Materials <br /> Signature r. Print/Typed Name Date < r <br /> Transporter 2: M Permit# \ Date <br /> Address Signature <br /> Printed Name <br /> Autoclave/Transfer aClllty Incineration Facili Incineration Facility Alt Treatment Facili Processin F'S <br /> WMHS Vernon WMHS Escondido Covanta Energy HEST Services Aemerge RedPak Healthwise Services <br /> 4280 Bandini Blvd 1996 Don Lee Place 5751 Triana 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(256)882-1019 Phone(701)282-7373 Hesperia CA,92345 Phone(559)834-3333 <br /> Permit#: TS/0ST 81 Phone(760)489-5009 Permit#:709-1104 Permit#:ITS-0203 Phone(760)9834808 Permit#:TS-89 <br /> Permit#:TS-73 Permit#:TSIOST 135 <br /> Signature Signature Signature Signature SignatureSlgnature <br /> Date .Date Date Date Date Date <br /> iscrepancy. Treatment Facility Certification of Receipt and Destruction <br /> "I certify that the contents of the listed containen(s)have been received,treated,, Fd,- <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 Certification:"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 /> marked 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 /> Signature <,' Print/Typed Name X' Date I`' <br /> �i0 'd 'ON M UIIb 5I l l IlHZ/6i0Z/iZ/g�� <br />