Laserfiche WebLink
vii \ YA MEDICAL WASTE TRi ING DOCUMENT <br />SERVICE DATE: t <br />WASTE MANAQEMENT <br />edwasteawmacolm ROUTE NO, — SA204 'TRUCK NUMBER <br />Seq Generator No. 24 -Hour Emergency Response <br />�. T _ Y COWUNrry (800) 424-9300 <br />HOWMA State Generator's ID No. <br />1420 N Tracy Blvd <br />Tracy, CA 96370-U6 I Generator's US EPA ID No. <br />I 2a. Description of Waste 2b. Container Type 2c. No of <br />Contained <br />14 gulated Medical :o.s,, - 1 (R ) 1 gal <br />® _ PGR <br />RegiffalsO Vedicafflaft 0.8., 6.2 31 GALLON (Regulattd Medital PaViological Wast*) 31 gal <br />� <br />Phafmace+afaceI� . "? G?kLLON (Pharmacetitical Waste) 31 9sl <br />W Ph*XrnQCek ,r, , <br />2 _ z <br />. . _ asTIVFY vveZKV) #11 go! <br />LJN 3PI, Flit <br />P441 *44 MR <br />vwwil, Pe'll <br />WHEMMMEMEMM <br />_J Transporter 1 is to check box if this Is a through shipment <br />OCU ENT " <br />CD <br />s c <br />ao � <br />(D <br />®Q <br />Ib. or a) Q <br />Volume > c� <br />iy ) A <br />r <br />Lo <br />r o <br />' > a c <br />8 <br />= o <br />Ea n� <br />=o E <br />0�? Zo <br />*- Transporter 1 Address: WM Healthcare Solutions, Inc. Applicable permit number/s: Escondido- 5688 — MW -172 r �, <br />1996 Don Lee Place Ste. C Phone #: (760) 489-5009 co a A <br />_Escondido, CA 92029...... Vernon- 5688 = MW -157 <br />H Transporter 1 Acknowledgement of Receipt of Materials Phone #: (323) 307-0514' <br />v — o r <br />~ SignaturePrint /Typed Name Date ro m <br />2° m <br />c c' <br />CL E <br />E <br />H CJo <br />is <br />Signature <br />Print/ Typed Name <br />6. <br />Discrepancy <br />Comments <br />aTD terminated New TD # <br />Permit number: <br />Date <br />2 Address: Smith Systems Transportation Phone #: 897-5571 <br />7. <br />Treatment Facility Printed Certification Receipt Treatment <br />mcm c <br />s m o <br />5. <br />Transporter (800) <br />of and <br />o <br />m m <br />a) m� <br />L-� <br />417 9th Ave, Scottsbluff, NE 69361 <br />"1 certify that the contents of the listed container/s have been received, treated <br />c E <br />P.O. Box 2455, Scottsbluff, NE 69363 <br />and disposed of in accordance with all local, state, and federal regulations." <br />g E Sw e: <br />Intermediate Handler 2 / Acknowledgement of Receipt of Materials <br />Prtnt Name <br />v -0-� 4 8 <br />Signature <br />Print/ Typed Name <br />6. <br />Discrepancy <br />Comments <br />aTD terminated New TD # <br />Permit number: <br />Date <br />Signature Date I I R <br />00 or <br />co, <br />U .a = <br />o <br />a) m� <br />L-� <br />d <br />v <br />,.a <br />U ° <br />0) <br />d mid <br />U) <br />ID C d <br />.. <br />Signature Date I I R <br />