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02/21/2018 831-13710001 0001994378 <br /> 40%8Medical Waste Tracking Document Routs No. TA30,7 <br /> vwA%� <br /> Customer-, <br /> DTH QUAIL CAKE 24-Hour Emergency Response (800)424-9300 <br /> 12Z1 Rosemarie Ln <br /> Sroclmon,CA 95207-6703 Customer service (853)309.0392 <br /> (209)477-0271 <br /> Description of Waats Container Type No.of Is,or <br /> containers volume <br /> UN3291,Regulated Medical Waste,N.O-S.,6.2,P U 43 GALLON(Regulated Medical Waste(Bio))43,000000 gal 2- <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-5588-MW-157 Phone#: (323)307-0514 <br /> Transporter 1 Acknowledgement/(4•Reeel 061,Material: 1 / <br /> 53gnature f �`.�_. '� Print/TyP Name ,"„�2:.:4• v rr ! Date Z <br /> Transporter 2;/ p4ormit Date <br /> Adder Signature <br /> Printed Name - <br /> Au clay aster F90111ty Transfer Facility Inpneration Fadliy Inclnem[ion Fade Ah Treatment Fat11l J Proos51n/rFS '�•. <br /> WMHS Vernon WMHS Escondido Covanta Energy HESI Sgndoas Aemerge ReclPak Healthwise Services <br /> 4280 Bandini Blvd 1996 ton Lee Place 5251 Trlana Blvd SW 1420 40th Street North Services S.C,LLC 4800 E.Lincoln Av. <br /> vemon,CA 90058 5utp3 C Huntsville.AL 35905 Fargo,ND 58102 9500 E.Avenue Fowler,CA 9,362,5 <br /> Phone(323)307-0514 Escondido,CA 9x029 phone(256)682-1019 Phone(701)282-7373 Hesperia CA,97345 Phone(559)834-3333 <br /> Permit ff' TS/OST 81 Pnone(760)489-S009 Permit 9:709.1104 Permit#:ITS-0203 phone(760)983-2806 PermitZ:T•S89 <br /> Permit+i;TS-73 Ftrmit 9:TS/05T 135''.. <br /> Signature Signature Signatue Signature <br /> re <br /> Date Date Date Date Date pate <br /> IScrepancy Tinaztmenit Fachtty Certification of Receipt and Destruction <br /> "I certify that the contents of the 115teo eontalner(s)have been recelved,treated,and <br /> dtspostd or at one or more of the facilities Indicated above In acoordence with all local,state, <br /> and federal regulations." <br /> omments <br /> Generators Cortdfle';Bpon:'I hereby declare that the contents of VS consignment are fully and accurately described above by the proper snipping name and eta classified,packaged, <br /> marked and labeled/placarded,and are in all mspeces In proper condition for transport by highway according to applicable international and national government regulations,Including <br /> applicable SMte regulations." <br /> /1 <br /> Signature Print/Typed Nance �Ci E a~ !r'ar°' Date <br /> 8i0 'd 'ON XV9 AV 91 : II nH1/610Z/1Z/9Hj <br />