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10/23/2018 831-13710001 0002086526 <br /> 40%17Y�l <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,PGII 43 GALLON(Regulated Medical Waste(Blo))43.000000 gal t <br /> Transporter 1: Totals <br /> WM Healthcare Solutions,Inc. Applicable Permits: i. <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 Z AcknovAedgement of Receipt of Materials <br /> Signature Print/Typed Name ! Date ✓ <br /> Transporter 2: Permit# Date <br /> Address Signature <br /> Printed Name <br /> JA,todgve/Transfer Facility Transfer Facility Incineration Facili Incineration Facility Alt Treatment Facii ProcesslngrrFS <br /> WMHS Vernon WMHS Escondido Covanta Energy HER Services Aemerge RedPak Healthwise Services <br /> 4280 Bandinl Blvd 1996 Don Lee Place 5251 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 Hesperla CA,92345 Phone(559)834-3333 <br /> Permit#: TS/OST 81 Phone(760)489-5009 Permit 9:709-1104 Permit#:ITS-0203 Phone(760)983-2808 Permit#:TS-89 <br /> Permlt#:TS-73 Permit#:TS/0S1"135 <br /> SignatureSignature Signature Signature Signature Signature <br /> Date Date Date bate Date Date <br /> 15crepancy Treatment racility!Uerti Matron of Receipt and Destruction <br /> 1 certify that the contents of the llsted contalner(s)have been received,treated,and <br /> disposed of at one or more of the facllfties indicated above In accordance with all local,state, <br /> and federal regulations." <br /> omments <br /> I <br /> Generator's Certification:'7 hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name and are classrned,packag <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,indudin <br /> applicable state regulations.' <br /> Signatuif -y ~ Print/Typed Name Date <br /> 910 ,J 'OH Xdj AV 51 : 11 nH1/610Z/1Z/9H <br />