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I!I�Nll �lll� E�I� �O�I `• Illilllllf�llfl <br /> 04/74/x018 831-13710001 0002042617 <br /> / r <br /> Medical Waste Tracking DOCUMent Route no. T)t207 <br /> Customer: <br /> DTH QUAIL LAKE 24-Hour Emergency Response (800)424.9300 <br /> 1221 Rosemarie Rn <br /> Stockton,CA 95207.6703 Customer Service (855)508-0382 <br /> (209)477-0271 <br /> Description of Warty Container Type No.of Ib.or <br /> Containers Volume <br /> UN3291,Regulated Medical Waste,N,0.5„6.2,PGII 43 GALLON(Regulated Medical Waste(Bio))43.000000 gal <br /> Transporter 1: Totals <br /> WM Healthcare SolUGorl6,Inc, Applicable Permits: <br /> 1996 Don Lee Place Ste.C Escondido-5688-MW-172 Phone u: (760)489-5009 <br /> Escondido,CA 9ZO29 Vernon-5686-MW-157 Phone#: (323)307-0514 <br /> Transporter 1 Acknowled ement or Receipt:of <br /> Signature print/Typed Name )11� 1:C. /-,1 , '*S Dace <br /> Trasport¢r 2i,� Permit# / <br /> Dace <br /> Address I✓ Signature <br /> Printed Name <br /> Autod nsfer Fadlity Indnemtlon FArlll n0ner9tion Secll'. Alt Treatment Paclliv Pnxessln 5 � <br /> WMHS Vernon WMHS Escondido Covanta Energy HSI Services Aemarge Radsak Healthwise Services <br /> 4280 MOO Blvd 1996 Don tee Place 5251 Trlara Bfvd SW 1420 40th Street North Sew'=S-G,LLC 4800 E.Lincoln Av. <br /> vcrnon,CA 90058 Suite C Huntsville,AL 35805 Fargo,ND 56102 9600 E.Avenue Fowler,CA 93625 <br /> Phone(323)307-0514 Escondldo,CA 92029 Phone(x56)88.2-1019 Phone(701)282-7373 Hesoeda CA,92348 s'' Phone(559)834.3333 <br /> Permit S: TS/OST Al Phone(760)489^5009 Permit a:709-1104 Permit 9:ITS-0203 Phone(760)983-2848 Permit a:TS-89 <br /> Permit 8;T5^73 Permit S:TS109T 135 <br /> i� <br /> Signature Signature Signature Signature Signature �-S' ore -✓ <br /> Date Date Date Date Date Oats <br /> ;screpency Treatment racllity Ccrtinratlop of Receipt and vestruction <br /> "I Certify that the contents of the Ilmd oantalnsr(s)have been recelvecl,treated,and <br /> disposed of at one or more of the facilities IndIcarAd above In acdordanoa with all local,state, <br /> and rederal reoulations." <br /> mments <br /> Generator's Certlflegotlon�rs Z^hereby declare that the con ants of this Consignment are Nily and accurately described above by Ne proper shipping name and are classified,packaged, <br /> marked and lebeled/plamrcfed,aritl gore in an reepeM In proper condition for transport by highway according to applicable international and natlorknl govemmerrt regulations,including <br /> apDlieeble state rcgulatlolii" !c✓", r � <br /> Signature Print/Typed Name Dat® <br /> rg <br /> L10 'J 'OH Xd,j PIV 9I : I I I1HI/6I0UH/RE <br />