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6' Discrepancy <br />CL E <br />�E Comments <br />N V <br />O <br />El TD terminated New TD # Signature Date <br />xs fk <br />WM <br />-0-U0DZo <br />0 a- 3 0 <br />(D 3 <br />- <br />0 <br />N � <br />-n <br />00 <br />0 A <br />y Cn w O m ti <br />Cnm <br />A�j <br />Ii1} AD <br />IF <br />N W (D <br />4. <br />Transporter 1 is to check box if this is a through shipment <br />TOTALS�� D <br />(( <br />1kYfr N <br />Transporter 1 Address: WM Healthcare Solutions, Inc. Applicable permit number/s: Escondido- 5688 — MW -172 <br />1996 Don Lee Place Ste. C <br />Phone #: (760) 489-5009 <br />_ <br />Escondido, CA 92029 ,_ . t _.-_ __ <br />Transporter 1 Acknowledgement of Receipt of'Materi 1s <br />_ Vernon--5688--MW-157-- <br />Phone : (323) 307-0514 <br />A <br /># <br />~ <br />3 <br />Print / Typed Name <br />- Ff e. Date {`. R l <br />Signature .s" , .� ,' F k <br />9' _ <br />/ INrt�.Ja�CY.Sv`+.. <br />5, Transporter 2 Address: Smith Systems Transportation Phone #: (800) 897-5571 7. Treatment Facility Printed Certification of Receipt and Treatment <br />N w <br />417 9`" Ave, Scottsbluff, NE 69361 <br />"1 certify that the contents of the listed container/s have been received, treated <br />P.O. Box 2455, Scottsbluff, NE 69363 <br />and disposed of in accordance with all local, state, and federal regulations." <br />E <br />Intermediate Handler 2 / Acknowledgement of Receipt of Materials <br />Print Name <br />C "= <br />Ic <br />Signature Permit number: <br />Print /Typed Name Date <br />6' Discrepancy <br />CL E <br />�E Comments <br />N V <br />O <br />El TD terminated New TD # Signature Date <br />