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wwne <br />WASTE MANAGEMENT <br />mdadwshafto-wm-enm <br />MEDICAL WASTE TRACKING DOCUMENT <br />SERVICE DATE: 11/29/2011 <br />ROUTE NO. — SA114 TRUCK NUMBER <br />DocuMEN�pllll0lbg044lllge <br />`m <br />Applicable permit number/s: Escondido- 5688 - MW -172 <br />Generator No. <br />24 -Hour Emergency Response <br />❑il <br />7A. TranstlFacSeq <br />_ <br />N <br />(800) 424-9300 <br />WM H,.,aithcare Solutions, I" <br />aywar Enterprise <br />HM45 <br />Hayward, CA 6-89 <br />Phone (512)356-6901 <br />a <br />1 <br />SUTTER TRACY CONWIUNITY <br />HOSMA <br />State Generator's ID No. <br />cL <br />4) <br />£= <br />r m <br />o o <br />949-680001 <br />1420 N Tracy BlvdSignature. <br />Tracy, CA 95376-346'1 <br />y C m <br />c da <br />Permit #. TS -96 <br />gate <br />Generator's US EPA ID No. <br />m � <br />.1 <br />r <br />O <br />713. Transfer Facility: <br />W1v1 Healthcare Solutions, Inc. <br />o) 682.6v <br />2a. Description of Weli to <br />2b. Container Type <br />2c. No of <br />t^,ontalners <br />2d. Ib. or <br />Volume <br />keguateueeutcalvNa5v, 40 , 6 < <br />r °11_1141. PGO <br />Regulated medlcalW?'4-, N 0,s., b 2 <br />UN 3291 PGI! <br />31 GALLON (Regulated Medical Chemotherapy Waste) 31 gal <br />31 GALLON (Regulated Medical Pathological Waste) 31 gal <br />m Q. <br />a <br />=o <br />�y <br />�i <br />Q <br />5337 Luce Avenue, BLDG 243G <br />McClellan, CA 95652 <br />Phone (512) 356-8907 <br />Permit #: TS -98 <br />Signature <br />wrr1 <br />Z <br />W <br />/w <br />VV <br />irrnar:Ne,Ereat vva <br />Pharmaceutical Wast <br />Regulated MedKaivvas4e, Au 0 S., 6 <br />UN 3291, PGII <br />31 GALLON (Pharmaceutical Waste) 31 gal <br />43 GAi_LON (Regulated Medical Chemotherapy VVast '3 gal <br />m a <br />m c <br />r <br />nate <br />n 7C. Incineration Facility <br />WMRRRC <br />Tsos state Hwy 65 <br />Anahuac, TX 77514" <br />Phone (409) 267.3913 <br />Regulated Medic -it Wase, N n S, 2 <br />U>v13291, PGii <br />43 GALLON `Re ulated Medical Pathological �V a 43 al <br />i g � ) g <br />A 10 <br />E <br />Permit#: MSW 2239-A <br />armateut ca _ <br />43 u.ALL (Pharmaceutical Waste) 4a gal <br />c <br />7D, Autoclave Facility: <br />d Sag <br />utlarrn aCei�'rc�314'V4'iP <br />am <br />45 <br />+�+ N <br />c <br />Waste Management <br />_M <br />N <br />C E <br />1390 E Commercial Row <br />Reno, NV 69512 <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 <br />E] 7E. TransferFacility; <br />`m <br />Applicable permit number/s: Escondido- 5688 - MW -172 <br />rn <br />� <br />Phone #: (760) 489-5009 <br />_ <br />N <br />Escondido, CA 92029 <br />Vernon- 5688 — M 157 <br />a <br />Transporter 1 Acknowledgement of Receipt of Materials <br />L° <br />F' <br />hone #: 23) 307-0514 <br />� 1� r'l % % / / <br />cL <br />4) <br />£= <br />r m <br />o o <br />Print /Typed Name Vi./ Date G7L / <br />7 <br />y C m <br />c da <br />$w <br />=c6 <br />m � <br />.1 <br />r <br />O <br />= L <br />U <br />a <br />• <br />.d <br />m w <br />m <br />a`s <br />�2 <br />y 00 <br />� Ori <br />m Q. <br />a <br />=o <br />_:E <br />v <br />cc <br />75 <br />w §� <br />'- Transporter 1 Address: WM Healthcare Solutions, Inc. <br />Applicable permit number/s: Escondido- 5688 - MW -172 <br />Healt <br />4280 4280 Bananndini aomuons, enc. <br />Bl Blvd. <br />1996 Don Lee Place Ste. C <br />Phone #: (760) 489-5009 <br />Vernon, CA 90058 <br />Escondido, CA 92029 <br />Vernon- 5688 — M 157 <br />Phone (323) 307-0514 <br />Permit#:TS/gST81 <br />Transporter 1 Acknowledgement of Receipt of Materials <br />L° <br />F' <br />hone #: 23) 307-0514 <br />� 1� r'l % % / / <br />Signature <br />Date <br />Signature �2a.-- �'- " <br />IN <br />Print /Typed Name Vi./ Date G7L / <br />7 <br />y C m <br />c da <br />5, I Transporter 2 Address: Smit"ystems Transportation Phone #: (800) 897-5571 <br />J 417 Wh 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 />EJTD terminated Now TD # <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 disposed of in accordance with all local, state, and federal regulations." <br />Print Name <br />Signature <br />Date <br />0-- <br />EE a ai <br />d 8, <br />c: <br />= c -=o <br />E m <br />O <br />C V <br />Z <br />m <br />y Nam <br />13 <br />m <br />L, d <br />§L <br />Stum <br />F- <br />y C m <br />c da <br />r LL <br />L <br />c <br />=c6 <br />d E <br />8 m ii <br />d <br />0 <br />~ <br />m w <br />m <br />a`s <br />i <br />y 00 <br />m Q. <br />m a <br />m c <br />r <br />� <br />� <br />' m <br />E <br />C <br />E <br />is <br />c <br />d Sag <br />r- <br />am <br />45 <br />+�+ N <br />c <br />`110 <br />_M <br />N <br />C E <br />d v m <br />� ro� <br />