Laserfiche WebLink
11/13/2015 831-13710001 0002094793 <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 lo.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 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 AcknovAedgpment of Receipt of Materials / <br /> SignatureY ';;'" j Print/Typed Name ? 1: �, "F ;r i,' Date <br /> Transporter 2: Permit Date <br /> Address Signature <br /> Printed Name <br /> AutoclavWM,ansfer Facll Transfer Facility Incineration Facility Incineration Facility Alt Treatment Facility VrocessingliTS <br /> WMHS Vernon WMH3 Escondido Covanta Energy HEST Services Aemerge RedPak Healthwlse Services <br /> 4280 Bandini Blvd 1996 Don Lee Place 5251 TTlana 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 56102 9600 E.Avenue Fowler,CA 93625 <br /> Phone(323)3D7-0514 Escondido,CA 92029 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#:709-11.04 Permit#:ITS-0203 Phone(760)983-2908 Permit#:TS-89 <br /> Permit#:TS-73 Permit#:TS/OST ISS <br /> Signature Signature Signature Signature Signature '%naralte__; <br /> Date Date Date Date Date Date <br /> Iscrepancy Treatment Facility Certification o eceipt and Destruction <br /> "I certify that the contents of the listed contalner(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 /> enerator's Certification:"I hereby declare that the contents or 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 /> applicable state regulations." ,- <br /> ignature l/ t ./ ��` �- 'ti Print/Typed Namef • <br /> r; �:�. Date <br /> ;. <br /> i I0 'd 'OH Xdd U�Id i l i f1H1/6l OZ/l Z/did <br />