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02/13/2019 831-13730001 0002170270 <br /> w�TE �rAN.��..v.CNT <br /> ® Medical Waste Tracking Document Route No. TR301 <br /> Customer: <br /> DTH WEBER OAKS 24-Hour Emergency Response (800)4249300 <br /> 2740 N California St <br /> Stockton,CA 95204-5529 Customer Service (855)508-0392 <br /> (209)466-3522 <br /> Description of Waste Container Type No.of iia,g <br /> Containers {^Volume <br /> UN3291,Regulated Medical Waste, N.O.S., 6.2, PGH 43 GALLON(Regulated Medical Waste(Bio))43.000000 gal <br /> Transporter 1: Totals ! ? + <br /> V <br /> WM Healthcare Solutions,Inc. Applicable Permlts: <br /> 1996 Don Lee Place Ste. C Escondido-5688-MW-172 Phone#: (760)489-5009 <br /> Escondido,CA 92029 Vernon 5688-MW-157 Phone#k: (323)307-0514 <br /> Transporter 1 AcknowledgEmant o Receipt of Materials � <br /> Signature g , Print/Typed Name "� c ;;r �.. Date .. <br /> Transport4ai•` Permit# '� Date <br /> Address Signature <br /> Printed Name <br /> Autoclave/Transfer Facili Tdnsfer Fall Inclneratlon Facili Incineration Facility Alt Treatment Facile Processin S <br /> WMHS Vernon jWM LODI Covanta Energy HESI Services Aemerge RedPak Healthwlse Services <br /> 4280 6andlnl Blvd 1. 5251 Titan Blvd SW 1420 40th Street North Services S.C.,LL 4600 E.Lincoln Av. <br /> Vernon,CA 90058 1 1333 E.Turner Rd Huntsville,AL 35805 Fargo,ND 58102 9600 E.Avenue p Fowler,CA 93625 <br /> Phone(323)307-0514 Lodi,Ca 95240 r Phone(256)882-1019 Phone(701)282-7373 Hesperia CA,92345 Phone(559)8343333 <br /> Permit#: TS/OST 81 permitT/S 34 Permit#:709-1104 Permit#:ITS-0203 Phone(760)9832808 Permit#:TS-89 <br /> Permit#:TS/OS['135 <br /> Signature SignatureSignature Signature Signature J <br /> Date i ____ Date Date Date <br /> iscrepancy Treatment Facility Certification 57 Receipt and Destruction <br /> "I certify that the contents or 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 /> omments <br /> enerat:or's Certification:"I hereby declare that the contents or this consignment are fully and accurately described above by the proper shipping name and are classified,package <br /> marked and labeled/placarded,and are to all respects in proper condition for transport by highway according to applicable international and national government regulations,including <br /> applicable skate regulations." <br /> Signature A° <br /> Print/Typed Name ' ,. <br /> Date _ <br /> 600 'd 'ON M WV Oi : i I I1H1,/6IOZ/iZ/ddd <br />