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7- <br /> 07/24/2018 831-13710001 0002052717 <br /> WASTE M.�N.�EN.ENr <br /> Medical Waste Tracking Document Route No. TR207 <br /> Customer. <br /> DTH QUAIL LAKE 244Hour Emergency Response (800)424-9300 <br /> 1221 Rosemarie Ln <br /> Stockton,CA 95207-6103 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,N.O.S,6.2,PGI2 43 GALLON(Regulated Medical Waste(Bio))43.00 0000 gat <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 I Ack ledq:Zn=ipt of Materials <br /> Signature Print/Typed Name Date <br /> Transporter,': Permit# Date <br /> I <br /> Address zl� Signature <br /> Printed Name <br /> lAutDdavefTransftr ftcility Transfer Facility Incineration Facility, Incineration Facility Alt TYeatment Facility Pro'c'm" Ing/TFS <br /> WMHS Vernon WMHS Escondido Covanta Energy HESI Services Aemerge RedPak Healthwlse Sierv)Os <br /> 4280 Bandini Blvd 1996 Don Lee Place 525ITriana Blvd SW 1420 40th Street North Services 5.C.,-LLC f 4800 E.Lincoln 0. <br /> Vernon,CA 90058 Suits C Huntsville,AL 35805 Fargo,ND 58102 9600 E.Avenue Fowler,CA 93625 <br /> Phone(323)307-0514 �sc6ndido,CA 92029 Phone(256)882-1019 Phone(701)282-7373 Hesperia CA,92345 Phone(559)8343333 <br /> Permit#: TS/OST 81 Phone(760)489-5009 Permit#;709-1104 Permit#.1TS-0203 Phone(760)993-2808 Permit <br /> . Permit#;TS-73 Permit#:TS/OST f, <br /> Signature— Signature— Signature— Slqnafvre Signature <br /> Date Date Date Date Date Date <br /> )hscrepancy Treatmentr0drit—yTe-Millcat ion of Recelpt and Dt8truCtiOn <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 /> ,ornment"s <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 regulauuns,inciumny <br /> applicable state regulatigns." <br /> Signature Print/Typed Namo Date <br /> Z10 'd 'ON M t1 : 11 M/610UH/gH <br />