Laserfiche WebLink
vwrne <br />WASTE MANAGEMENT <br />medwastemm.com <br />MEDICAL WASTE TRACKING DOCUMENT <br />SERVICE DATE: 11/08/2011 <br />ROUTE NO. — SA204 TRUCK NUMBER <br />DocUMEN 00004429d <br />Transporter 1 Address: WM Healthcare Solutions, Inc. <br />1996 Don Lee Place Ste. C <br />Escondido, CA 92029 <br />Transp 1 Acknowledgement of Receipt of Materials <br />H Signature (J" /"may <br />Applicable permit numbers: <br />Escondido- 5688 - MW -172 <br />Phone #: (760) 489-5009 <br />Vernon- 5688 - MW -157 <br />/ Phone #: (323) 307-0514 <br />Print/ Typed Name �/��r �' ��Date /% '6 -// <br />!Tradiporter 2 Address: Smith Systems Transportation Phone #: (800) 897-5571 <br />417 9"' 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. Discrepancy <br />Comments <br />TD terminated New TD # <br />Permit number: <br />Date <br />Wivi Heaiftare aownons, mc. <br />4280 Bandini Blvd. <br />Vernon, CA 90058 <br />Phone(323)307-0514 <br />Permit #:TS/OST 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 <br />Seq <br />Generator No. <br />949-880001 <br />24 -Hour Emergency Response <br />far Facility: <br />(800) 424-9300 <br />Snlutinns, l <br />SUTTER TRACY GOMv�1NITY <br />HOSPITAV' <br />949-6$0001 <br />901 <br />State Generator's ID No. <br />1420 N Tracy Bled <br />Tracy, CA 95376-3451 <br />Date <br />Generator's US EPA ID No. <br />m B. Transfer Facility: <br />- 7 <br />WM Heatthoare Solutions, mc. <br />El <br />McClellan, Ilan, CA 95662LDG 243G <br />Phone 356-8907 -8907 <br />Permit # TS 9 <br />Signature <br />Date <br />O5UN <br />2a. Description of Waste <br />2b. Container Type <br />2c. No of <br />Containers <br />2 d. <br />u e <br />Regulated Medical Wasle, N.O.S., 6.2 <br />3291, PGII <br />31 GALLON (Regulated Medical Waste (Bio)) 31 gal <br />Regulated Medical Wass, N.O.S., 6.2 <br />UN 3291, PGii <br />43 GALLON (Regulated Medical Waste (Bio)) 43 gal <br />! <br />W <br />W <br />� <br />;^\ <br />"J <br />r <br />7C. Incineration Facility; <br />WMRRRC <br />7505 State Hwy 65 <br />t <br />Anahuac, TX 77514 <br />Phone (409) 267-3913 <br />Permit If. MSW 2239-A <br />El 70. Autoclave Facilltq: <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 />4' <br />Transporter 1 is to check box if this is a through shipment <br />TOTALS E=:� <br />M4E, Transfer Facility: <br />Transporter 1 Address: WM Healthcare Solutions, Inc. <br />1996 Don Lee Place Ste. C <br />Escondido, CA 92029 <br />Transp 1 Acknowledgement of Receipt of Materials <br />H Signature (J" /"may <br />Applicable permit numbers: <br />Escondido- 5688 - MW -172 <br />Phone #: (760) 489-5009 <br />Vernon- 5688 - MW -157 <br />/ Phone #: (323) 307-0514 <br />Print/ Typed Name �/��r �' ��Date /% '6 -// <br />!Tradiporter 2 Address: Smith Systems Transportation Phone #: (800) 897-5571 <br />417 9"' 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. Discrepancy <br />Comments <br />TD terminated New TD # <br />Permit number: <br />Date <br />Wivi Heaiftare aownons, mc. <br />4280 Bandini Blvd. <br />Vernon, CA 90058 <br />Phone(323)307-0514 <br />Permit #:TS/OST 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 <br />