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<br />WASTE MANAGEMENT
<br />rseadwssta.wlm.com
<br />MEDICAL, WASTE TRACKING DOCUMENT
<br />SERVICE DATE: 11/01/2011
<br />ROUTE NO. — SA204 TRUCK NUMBER
<br />oocu.en*11JI111111111111111111
<br />0000442927
<br />` Transporter 1 Address:
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<br />WM Healthcare Solutions, Inc.
<br />1996 Don Lee Place Ste. C
<br />Escondido, CA 92029
<br />gement of Receipt of Materials
<br />Applicable permit number/s:
<br />Escondido- 5688 - MW -172
<br />Phone #:(760)489-5009
<br />Vernon- 5688 - MW -157
<br />Phone #:(323)307-0514
<br />Print / Typed Name 7 A, 1���5 DateLl
<br />S. I Transporter 2 Address: Smith Systems Transportation Phone #: (800) 897-5571
<br />J 417 a Ave, Scottsbluff, NE 69361
<br />P.O. Box 2455, Scottsbluff, NE 69363
<br />Intermediate Handler 2 / Acknowledgement of Receipt of Materials
<br />Signature
<br />Print/ Typed Name _
<br />6.
<br />Discrepancy
<br />Comments
<br />F] TD terminated New TD #
<br />Permit number:
<br />Date
<br />vvm neaaneare aorunons, mo.
<br />4280 Bandini Blvd.
<br />Vernon, GA 90058
<br />Phone (323) 347-0514
<br />Permit #:TS/dST 81
<br />Signature
<br />Date
<br />7. Treatment Facility Printed Certification of Receipt and Treatment
<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 />Date
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<br />--------------------
<br />Seq
<br />----
<br />Generator No. 949-680001
<br />24 -Hour Emergency Response
<br />7A, Transfer Facility:
<br />(800) 424-9300
<br />WIM Healthcare Solutions, IN
<br />3670 Enterprise Ave
<br />Hay,vr,d, CA 94545
<br />Phone (512) 356.8901
<br />Permit a: Ts -96
<br />1. SUTTER TRACY COMMUNITY
<br />HOSPITA
<br />949-680001
<br />State Generator's ID No.
<br />1420 N Tracy Bird
<br />Signature_
<br />Tracy, CA 95376-3451
<br />Generator's US EPA ID No.
<br />Date__ _
<br />209 832-6012
<br />2a. Description of Waste
<br />2b. Container Type
<br />2c. No of
<br />ontainers
<br />2d. Ib. or
<br />Volume
<br />7g; Treinsfer. cftity;
<br />WM Healthcare Solutions; Inc.
<br />Regulated Medical Wast, N.O.S., 6.2
<br />UN 3291, PGiI
<br />31 GALLON (Regulated Medica! Waste (Bio)) 31 gal
<br />O
<br />5337 Luce Avenue, BLDG 243G
<br />McClellan, GA 95652'
<br />Phone {512} 35&690?
<br />Permit #: Ts -ss
<br />�.
<br />Regulated Medical Wast, N.O.S., 6.2
<br />9
<br />43 GALLON (Regulated Medical Waste (B!o)) 43 gal
<br />UN 3291, PGiI
<br />Signature
<br />WDate
<br />[-] 7C. Incineration Facility,
<br />2i
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<br />WMRRRC
<br />7505 State Hwy 65
<br />Anahuac, TX 77514
<br />Phone (409) 267.3913
<br />Permit #: MSW 2239-A
<br />❑ 7D. Autoclave Facility:
<br />Waste Management
<br />1390 E Commercial Row
<br />Reno, NV 89512
<br />Phone (775)326-2409
<br />Permit # MSWL-003
<br />IWH-004
<br />7E. Transfer Facility:
<br />4'
<br />Transporter 1 is to check box if this is a through shipment
<br />TOTALS ���%
<br />` Transporter 1 Address:
<br />r
<br />0
<br />Transp rter 1 Ackno
<br />~ Signature
<br />T
<br />C
<br />M
<br />,
<br />42 E
<br />0 O
<br />c�
<br />WM Healthcare Solutions, Inc.
<br />1996 Don Lee Place Ste. C
<br />Escondido, CA 92029
<br />gement of Receipt of Materials
<br />Applicable permit number/s:
<br />Escondido- 5688 - MW -172
<br />Phone #:(760)489-5009
<br />Vernon- 5688 - MW -157
<br />Phone #:(323)307-0514
<br />Print / Typed Name 7 A, 1���5 DateLl
<br />S. I Transporter 2 Address: Smith Systems Transportation Phone #: (800) 897-5571
<br />J 417 a Ave, Scottsbluff, NE 69361
<br />P.O. Box 2455, Scottsbluff, NE 69363
<br />Intermediate Handler 2 / Acknowledgement of Receipt of Materials
<br />Signature
<br />Print/ Typed Name _
<br />6.
<br />Discrepancy
<br />Comments
<br />F] TD terminated New TD #
<br />Permit number:
<br />Date
<br />vvm neaaneare aorunons, mo.
<br />4280 Bandini Blvd.
<br />Vernon, GA 90058
<br />Phone (323) 347-0514
<br />Permit #:TS/dST 81
<br />Signature
<br />Date
<br />7. Treatment Facility Printed Certification of Receipt and Treatment
<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 />Date
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