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wwuze <br />WASTE MANAGEMENT <br />medwastemm.com <br />MEDICAL WASTE TRACKING DOCUMENT <br />SERVICE DATE: 11/22!2011 <br />ROUTE NO. - SA204 TRUCK NUMBER <br />oocuNE 0000488146 <br />Transporter 1 Address: WM Healthcare Solutions, Inc. Applicable permit number/s: Escondido- 5688 — MW -172 <br />P <br />seq <br />Generator No, 949-680002 <br />24 -Hour Emergency Response <br />El 7A. Transfer FacU <br />Phone (323) 307.0514 <br />(800) 424-9300 <br />367 Enterpris Solutions, in¢. <br />8$7� Enterprise Ave. <br />0 <br />,. SUTTER TRACY IIAMING GTR <br />d <br />—� o <br />CLs <br />949-080002Hayw <br />1530 Bessie Ave #109 <br />d CA 94545 <br />P ni re 9oe-39ot <br />State Generator's ID No. <br />�2 <br />Tracy, CA 95376-3080 <br />�c <br />Generator's US EPA ID No. <br />-,ze <br />Debbie Denton <br />c � <br />U <br />2a. Description of Waste <br />2b. Container Type <br />2c. No of <br />Containers <br />2d. Ib. or <br />Volume <br />TB. Transfer Facility: <br />WM Healthcare Solutions, Inc. <br />Regulated Medical Wasle, N.O.S., 6.2 <br />UN 3291. PGII <br />31 GALLON (Regulated Medical Waste (Bio)) 31 gal <br />O <br />5337 Luce avenue, BLDG 243G <br />McClellan, CA 9565 <br />Phone (512) 356-8 <br />lift <br />e <br />Regulated Medical Waste, N.O.S., 6.2 <br />UN 3291, PGII <br />43 GALLON ulated Medical Waste (Bio)) 43 gal <br />m <br />LL <br />a <br />C <br />Permit a; Ts -98 <br />Signature <br />ate Z2- <br />W <br />WQ <br />m <br />7C. Incineration Facility; <br />y U <br />WMRRRC <br />7505 State Hwy 65 <br />cc <br />ii <br />o_ <br />Anahuac, TX 77514 <br />E " 1i <br />C: o <br />WE 00 <br />E <br />Cesar <br />Z <br />Phone (409) 267-3913 <br />-0 <br />Permit #: MSW 2239-A <br />LL <br />d m� <br />IL q <br />d <br />7D. Autoclave Facility: <br />t m <br />.01 <br />rova <br />I <br />Waste Management <br />T <br />1390 E Commercial Row <br />Reno, NV 89512 <br />w - <br />m <br />c <br />Phone (775) 326-2409 <br />Permit #; MSWL-003 <br />IWH-034 <br />4' <br />Transporter 1 is to check box if this is a through shipment <br />TOTALS ��� <br />l <br />L13 <br />7E. Transfer Facility: <br />Transporter 1 Address: WM Healthcare Solutions, Inc. Applicable permit number/s: Escondido- 5688 — MW -172 <br />P <br />WM Healthcare Solutions, Inc. <br />4280 Bandini Blvd.. <br />` 1996 Don Lee Place Ste. C Phone #: (760) 489-5009 <br />Vernon, CA 80058 <br />Escondido, CA 92029 Vernon. -5688 — M -157 <br />Phone (323) 307.0514 <br />Transporter , Acknowledgementof--R e� rials Phone #,, 23) 307-0 14 <br />Permit #;TS/OST e1 <br />E <br />~ Signature --,,�- Print/ Typed Name ''moi Yv� � � ate ( �°� (� <br />Signature <br />Date - <br />yr <br />CL E <br />so <br />CV <br />5:I Transporter 2 Address: Smith $Vstems'rransportation Phone #: (800) 897-5571 <br />J 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 />QTO terminated New TO # <br />Permit number: <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 dispo ` dance with al,lol tate, a federal regulations." <br />Print Name `` <br />Signature <br />1 <br />Date <br />E <br />Ca <br />'a <br />n9 <br />w <br />o C <br />d <br />—� o <br />CLs <br />�2 <br />�c <br />c � <br />U <br />_, <br />W w <br />U ro <br />U <br />tl p <br />m <br />LL <br />a <br />C <br />m <br />y U <br />I <br />cc <br />ii <br />o_ <br />E " 1i <br />C: o <br />WE 00 <br />E <br />Cesar <br />Z <br />U a <br />-0 <br />N <br />4 N <br />LL <br />d m� <br />IL q <br />d <br />`C CL <br />c C <br />t m <br />.01 <br />rova <br />I <br />�c2 <br />m or <br />T <br />m <br />a � � <br />w - <br />m <br />c <br />