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vv�na <br />WASTE MANAGEMENT <br />ma-dwasta-wm_com <br />MEDICAL WASTE TRAP§I FOCUMENT <br />SERVICE DATE: VV �� <br />ROUTE NO. — SA204 TRUCK NUMBER <br />IININIINIIgIIAI <br />DocUMENT #: 0000502193 <br />Transporter 1 Address: WM Healthcare Solutions, Inc. <br />1996 Don Lee Place Ste. C <br />o Escondido, CA 92029 <br />cTransporter 1 Acknowledgement of Receipt of Materials <br />Signature�'- <br />5. 1 Transporter 2 Address: <br />Signature <br />Print / Typed Name — <br />6. Discrepancy <br />Comments <br />RTD terminated New TD # <br />Applicable permit number/s: Escondido- 5688 — MW -172 <br />Phone #: (760) 489-5009 <br />Print / Typed Name <br />Phone #: ( ) <br />Permit number: <br />Date <br />Vernon- 5688— W-157 <br />Phone # (323) 307-0514 <br />Date <br />Daniels Sharpsmart, inc. <br />4144 E Therese Ave. <br />Fresno, CA 93725 <br />Phone (559) 834-6252 <br />Permit #: TS/OST 55 <br />Signature <br />Date <br />7. Treatment Facility Printed Certification of Receipt and Treatment <br />"1 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 />E <br />a� <br />N <br />m <br />o� d- <br />CL � m <br />pQ" <br />m I <br />CL <br />L C <br />c 2 U <br />N i Y <br />� a e <br />—a <br />ar <br />� N <br />�2 <br />C C <br />� o W <br />w o � <br />y U I <br />f0 d d <br />CL vi m 0 <br />c o E W <br />v, <br />c zo` <br />U C. I 9 <br />N d <br />N C ? r LL <br />c a = c <br />m c <br />cvU a E <br />U N a m <br />W .62 <br />F - <br />N (M I <br />� -0 <br />w � <br />y � U <br />CX Q <br />°' o <br />T O .2 <br />m rn c <br />J. <br />2 E v <br />Y <br />0 <br />V 81)3m <br />a <br />ti= m m <br />U d C W a O F <br />Ri T <br />,4 d o <br />L 'v, N �'•, t <br />ltS U p pl <br />Gt � i0 N <br />m <br />seq <br />Generator No. <br />24 -Hour Emergency Response <br />❑7A. Transfer Facility: <br />(800) 424-9300 <br />WM Healthcare Solu <br />3670 Enterprise Avetions, Inc. <br />Hayward, CA 94545 <br />Phone (512) 356-8901 <br />Permit #: <br />Signature <br />Dat <br />HOSMA <br />"0-680001 <br />1420 N Tracy Blind <br />Tracy, CA 95376-3451 <br />(209) 832-6012--- <br />State Generator's ID No. <br />Generator's US EPA ID No. <br />O <br />�QQ+ <br />W <br />7S. Transfer Facility: <br />WM Healthcare Solutions, inc. <br />5337 Luce Avenue, BLDG 2430 <br />McClellan, CA 95652 <br />Phone (512) TS -356 89 .417 <br />98 <br />98 <br />Permit #: re <br />Signnature <br />A ate Z�- <br />2 a. Description of Waste <br />2b. Container Type <br />2c. No of <br />Containers <br />2d. Ib. or <br />Volume <br />UN 329'1, PGII <br />UN 3291, PGII <br />UN 3291, PGII <br />Re ulatedMedicalWastz N.O.S. 6.2 <br />armace Ca a galC j LI �f <br />.J l I7 <br />5 a a (? %-F <br />/ <br />N <br />�� <br />-7 <br />Facility: <br />WMRRRC <br />7505 State Hwy 65 <br />W <br />UN 3291, PGIItsineration <br />Anahuac, TX 77514 <br />Phone (409) 267-3913 <br />Permit #: MSW 2239-A <br />7D. Alternate Facility: <br />4. <br />Transporter 1 is to check box if this is a through shipment <br />TOTALS ��� <br />7E. Destination Facility: <br />Transporter 1 Address: WM Healthcare Solutions, Inc. <br />1996 Don Lee Place Ste. C <br />o Escondido, CA 92029 <br />cTransporter 1 Acknowledgement of Receipt of Materials <br />Signature�'- <br />5. 1 Transporter 2 Address: <br />Signature <br />Print / Typed Name — <br />6. Discrepancy <br />Comments <br />RTD terminated New TD # <br />Applicable permit number/s: Escondido- 5688 — MW -172 <br />Phone #: (760) 489-5009 <br />Print / Typed Name <br />Phone #: ( ) <br />Permit number: <br />Date <br />Vernon- 5688— W-157 <br />Phone # (323) 307-0514 <br />Date <br />Daniels Sharpsmart, inc. <br />4144 E Therese Ave. <br />Fresno, CA 93725 <br />Phone (559) 834-6252 <br />Permit #: TS/OST 55 <br />Signature <br />Date <br />7. Treatment Facility Printed Certification of Receipt and Treatment <br />"1 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 />E <br />a� <br />N <br />m <br />o� d- <br />CL � m <br />pQ" <br />m I <br />CL <br />L C <br />c 2 U <br />N i Y <br />� a e <br />—a <br />ar <br />� N <br />�2 <br />C C <br />� o W <br />w o � <br />y U I <br />f0 d d <br />CL vi m 0 <br />c o E W <br />v, <br />c zo` <br />U C. I 9 <br />N d <br />N C ? r LL <br />c a = c <br />m c <br />cvU a E <br />U N a m <br />W .62 <br />F - <br />N (M I <br />� -0 <br />w � <br />y � U <br />CX Q <br />°' o <br />T O .2 <br />m rn c <br />J. <br />2 E v <br />Y <br />0 <br />V 81)3m <br />a <br />ti= m m <br />U d C W a O F <br />Ri T <br />,4 d o <br />L 'v, N �'•, t <br />ltS U p pl <br />Gt � i0 N <br />m <br />