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02/13/2019 831-13730001 0002170270 <br /> LAU�®�ASY1E ��»A�����a <br /> Medical Waste Tracking Document Route No, iR301 <br /> Customer: <br /> DTH WEBER OAKS 24-Hour Emergency Response (800)424-9300 <br /> 2740 N Calffomia St <br /> Stockton,CA 95204-5529 Customer Service (855)508-+D392 <br /> (209)466-3522 <br /> Description of Waste Container Type No,of lb.or <br /> Containers Volume <br /> UN3291,Regulated Medical Waste,N.O.S.,6.2,PGH 43 GALLON(Regulated Medical Waste(Bio))43.000000 gal <br /> i <br /> Transporter 1: Totals <br /> I <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 7 <br /> Transporter 1 Acknowledgement off Receipt of Materials , ,a <br /> Signature �� Print/Typed Name Date <br /> Transporter 2; Permit# Date _ <br /> Address Signature <br /> Printed Name <br /> r ave/Transfer Fadli Transfer Facili Incineration Facility Incineration Facility Alt Treatment FacilitvProcessin /TFS I <br /> IS Vernon WM LODI Covanta Energy HESI Services Aemerge RedPak Healthwise Services <br /> 4280 Band ini Blvd 5251 Triana Blvd SW 1420 40th Street North Services S.C.,LLC 4800 E.Lincoln Av. <br /> Vernon,CA 90058 1333 F.Turner Rd Huntsville,AL 35805 Fargo,ND 58102 9600 E.Avenue Fowler,CA 93625 <br /> Phone(323)307-0514 Lodi,Ca 95244 <br /> Permit#: l S/OST 81 Phone(256)882-1019 Phone(701)282-7373 Hesperia CA,92345 Phone(559)834-3333 1 <br /> Permit T/S 34 Permit#:709-1104 Permit#:ITS-0203 Phone(760)983-2808 Perm.. . <br /> T5-89 99 <br /> Permlt#:T5/OST 135 <br /> Signature Signature Signature Signature Signature E <br /> Date I Date Date Date Date <br /> screpancy Treatment Facility Certification of Receiptand Destinaction <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." i <br /> mments <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 /> irked and labeled/placarded,and are in all respects in proper condition for transport by highway according to applicable international and national government regulations,including <br /> applicable state regulations." <br /> Signature Print/Typed Name Date <br />