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VjjtV_Ae <br />WASTE MANAGEMENT <br />Tredwastemm.com ROUTE No. - <br />Seq Generator No. 1 949-680001 <br />01. UTTER-nwNcYC01V*'NIT <br />Y <br />HOSPITA <br />949-680001 <br />1420 N Tracy Blvd <br />Tracy, CA 96376-3461 <br />2a. Description of Waste <br />6.2 <br />UN;YP, 1, PUM <br />Pegulate,qMefficalWa,44, ROR, 6-2 <br />UN MA1, POP <br />2b. Container Type <br />MEDICAL41ASTE TR, ING DocuME <br />SERVICE DATE: IV2512011 <br />W04 TRUCK NUMBER I <br />24 -Hour Emergency Response <br />(800) 424-9300 <br />State Generator's ID No. <br />31 GALl_0N lftguiigod Medical Wastw (Slo)) 91 Sol <br />4? G.4LLON (Rogulated MsdIcal Wasts (Bio)) 43gal <br />4. 4. Transporter 1 Is to check box If this Is a through shipment <br />TOTALS =* <br />20. No of <br />11111110111ill <br />DocUMENT#: <br />00M44-2-926 <br />2 <br />b. or <br />flume <br />& <br />72� <br />IL <br />0 <br />E& <br />rz r_ E C <br />im <br />C 1705 Z 0 <br />CL <br />LL <br />LL <br />'2, <br />1 <br />Transporter 1 Address: WM Healthcare Solutions, Inc. Applicable permit number/s: Escondido- 5688 — MW -172 <br />1996 Don Lee Place Ste. C Phone #: (760) 489-5009 <br />Escondido, CA 92029 Vernon- 5688 — MW -157 <br />Transporter 1 Acknowledgement of Receipt of Materials Phone #: (323) 307-0514 8 <br />Print/ Typed Name Date <br />Signature" �,/, I . . I 1� <br />ra. j Transporter 2 Address: Smith Systems Transportation Phone #: (800) 897-5571 <br />417 gth Ave, Scottsbluff, NE 69361 <br />P.O. Box 2455, Scottsbluff, NE 69363 <br />Intermediate Handier 2 1 Acknowledgement of Receipt of Materials <br />Signature Permit number: <br />Print/ Typed Name Date <br />Discrepancy <br />Comments <br />E1TD terminated Now TD # <br />7 Treatment Facility Printed Certification of Receipt and Treatment �t <br />"I certify that the contents of the listed container/s have been received, treated <br />and disposed of In accordance with all local, state, and federal regulations." <br />Print Name <br />Signature <br />L3 <br />4) X <br />Date <br />