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�II�IIIIII�II�III� �I�lll�llQlll�l� IIIII�I�II�II� <br /> 03/06/2018 831-13710001 0002042610 <br /> 4#%U��o Medical Waste Tracking Document Route No- TR207 <br /> WABTc wasawe4mcceraesaae-r <br /> Customer: <br /> DTH QUAIL LAKE 24-Hour Emergency Response (800)424-9300 <br /> 1221 Rosemaric(.n <br /> Stockton,CA 95207-6703 Customer Service (855)508-0392 <br /> (209)477-0271 <br /> Deser9pricn of Wit84m Container Type <br /> No,gf lb,or <br /> Containers volume <br /> UN3291,Regulated Medical Waste,N.O.S.,6.2,PGII 43 GALLON(Regulel;ed Medical Waste(Bia))43.00000 gal <br /> Transporter 1: Totals <br /> WM Healthcare Solutions,Inc. Applicabie Permits: <br /> 1996 Don Lee Place Ste.C Escondido-5688-MW-172 Phone M: (760)489-5009 <br /> Escondido,CA 92029 Vernon-5688-MW-157 Phone#; (323)307-0514 <br /> Transporter 1 ACIcn,qv4I,;d9CMC)5,ifRCc%i.py Cf Materials / <br /> Signaturerµ ,,., �� .Print/Typed Name /�t: Date <br /> r f <br /> Translport,e 2t/� Perhtit Yk Date <br /> ACAres;" Signatum <br /> Printed Name <br /> ngfier Feclky' Trensfer Feclli lntlnerodon Fac]i MdneNtfon Fadll Alt Treatment Fe<II Pro 5f15^�^5 <br /> WMHS vernon WMHS Escondido Covanta Energy HEST Services Aemerge RedPak /Hcaithwlsc Services \ <br /> 4280 Sandinl Blvd 1996 Don Lee Place 52s1 Trtana Blvd SW 14Z0 406+Street North Services S.G,LLC 4600 E.Lincoln Av. i <br /> Vernon,CA 90058 Sulte C Huntsville,Al 9S505 Fargo,ND 59102 9600 E.Avenue Fowler,CA 93625 <br /> Phone(323)307-0514 Escondido,CA 9ZOa9. Phone(256)692-1019 Phone(701)282-7373 Hesper4 CA,42345 Pnone(559)634-3333 <br /> Permit#: TS/OST 81 Phone(760)489-5009 Permit P:709-1104 Permit 41:ITS-0203 Phone(760)983-2808 Permit.#:TS-$9 <br /> Permit#:TS-73 Permit#:TS/OST 135 <br /> Signature Sipnatum Signature SignatureSignature <br /> Date Data Date Date Date I Date ~ <br /> tscrepancy Treatment Facility cer0flication or Receipt and DestmCDOn <br /> "I certify that the contents of the Ilsted contalner(5)havo been racatved,treated,and <br /> disposed of at one or more of the facilities indicated above in accordance with all local,=te, <br /> and federal regvla60ns.' <br /> Omment5 <br /> Generator's Certificatiopr'2 hereby declare Nat the contents or this consignment are fully and accurately described above by the proper shipping name and are classified,packaged, <br /> marked and labele Viclacarded,and are In all respects In propar condition for transport by hlgnwey aocording to appilcable interna ionei and national government regulations,including <br /> applicable state regulations.' <br /> Signature P19nt/Typed Name Date <br /> 010 ,J 'ON M �1 : 11 nH1/610Z/1Z/9HJ <br />