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wwune <br />WASTE MANAGEMENT <br />Seo I Generator No. <br />MEDICAL WASTE TRACKING DOCUMENT <br />SERVICE DATE: 11/08/2011 <br />ROUTE NO. — SA204 TRUCK NUMBER <br />SUTTER TRACY CONWIUNITY <br />HOSPITA <br />"0-680001 <br />1420 N Tracy Bhrd <br />Tracy, CA 95376-3461 <br />2a. Description of Waste <br />Regulated Medical Waste, N.O.S , 6 <br />UN 3291, PGII <br />Regulated Medical Waste, R.O.S., 6 <br />UN 3291, PGII <br />Pharmaceutical Waste, <br />Pharmaceutical W <br />PGII <br />PGII <br />Pharmaceutical Wasle <br />24 -Hour Emergency Response <br />(800) 424-9300 <br />State Generator's ID No. <br />Generator's US EPA ID No. <br />2b. Container Type <br />31 GALLON (Regulated Medical Chemotherapy Waste) 31 gal <br />31 GALLON (Regulated Medical Pathological Waste) 31 gal <br />31 GALLON (Pharmaceutical Waste) 31 gal <br />J Transporter 1 Is to check box if this is a through shipment 7 <br />Transporter 1 Address: WM Healthcare Solutions, Inc. <br />1996 Don Lee Place Ste. C <br />Escondido, CA 92029 <br />Transpoffb ;1 Acknowledgement of Receipt of Materials <br />TOTALS <br />2c. No of <br />Applicable permit number/s: Escondido- 5688 - MW -172 <br />Phone #: (760) 489-5009 <br />Vernon- 5688 - MW -157 <br />Phone #:(323)307-0514 <br />110111111111111 <br />DOCUMEN nnnn emrin <br />n7A. T ` * R ci ity: 4) <br />WM Healthcare Solutions, Inc. <br />.3670 Enterprlse Ave <br />Hayward, CA 94545 Q <br />€l-hane (512) 356.8901 w <br />€t nit N TS -96 _ <br />Signature <br />Date a o <br />b or `l9. Transfer Facility.- <br />it <br />acility d a VVM rlcaithcare Solutions, Inc <br />5337 Luce Avenue, BLDG 2436 <br />McClellan, CA 95652 3 <br />Permit i5}2) 356 8!347 `; > t1 <br />Permit 1: 7S-98 t <br />Signature $ a� <br />Date a <br />7C, Incineration Facility: m LL <br />WMIRARC s t; <br />7505 State Hwy` 65 y r <br />Anahuac,"rX 77514 <br />Phone (409) 267.3913 P <br />Permit #: MSW 2239-A '° c <br />7D. Autoclave Facility: ' Ci' m <br />W8fite.lVianisf.r.7 ;7 .0 N Z O <br />1300 E Commercial Row 0 a � a <br />Reno, NV 89512 rn 8 m <br />Phone (775) 326.2409 2 f°1 <br />Pelrnft#: MSWL-003 c '0 <br />iWH-004 _ 41 <br />c d <br />F 7E. Transfer Facility: o c o o m <br />WM Healthcare Solutions, Inc. 0 d <br />4280 Bandini Blvd. r d ~ <br />PhoneVerno(C3 507.0 ZcC <br />" Phone (323) 307�g514 d b c <br />Permit #:TS/09T 81 ro a <br />Signature c <br />/� m <br />Print! Typed Name T�� �Date /'/'� � �/ Date .01005 <br />j. <br />I Transporter 2 Address: Smith Systems Transportation Phone #: (800) 897-5571 <br />J 417 9a' Ave, Scottsbluff, NE 69361 <br />P.O. Box 2455, Scottsbluff, NE 69363 <br />Intermediate Handier 2 /Acknowledgement of Receipt of Materials <br />Signature <br />Print ! Typed Name <br />Discrepancy <br />Comments <br />TD terminated New TD # <br />Permit number: <br />Date <br />7. Treatment Facility Printed Certification of Receipt and Treatment m <br />"I certify that the contents of the listed container/s have been received, treated rico,' <br />and disposed of in accordance with all local, state, and federal regulations." <br />Print Name <br />Signature <br />r <br />�m 8 <br />?� mm c <br />CO to <br />M m 17 <br />r <br />N <br />sc c ii <br />8: � m <br />4 c <br />le U p p1 <br />C � N <br />(jmcx <br />Date a <br />