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<br />WASTE MANAGEMENT
<br />Seq I Generator No.
<br />ROUTE N0. —
<br />0 1' SUT rER TRACY COf11+fwwry-.
<br />HOSPfT ..
<br />949-080001..
<br />.1420 N Tracy BW
<br />Tracy. CA 95376-3451
<br />29. Description of Waete `
<br />Regulated Uedlcai Waste, N.O.S., 6.S
<br />I uu n2m Prti
<br />Regulated Medical Waster N,O.S., 6.1,
<br />UN 32St PGII
<br />Pharmaceuticalwaste, Phan
<br />waste'
<br />Regulated Medical Waste O.S.. 6:
<br />UN 324tN, PGII '
<br />Regulated Medical Waw, N.O.S.. 6.;
<br />UN 3241, PGII
<br />arm ce ca ase, ar
<br />waste
<br />MEDICAL WASTE TRACKING DOCUMENT
<br />SERVICE DATE:. 01110/2012
<br />04 TRUCK NUMBER
<br />24 -Hour Emergency Response
<br />---------jl (800) 424-9300 -
<br />State Generator's ID No.
<br />Generstor's.US EPA ID No.
<br />2c. No of
<br />2b. Container Type Contalner
<br />31 GALLON (Regulated. Medical Chemotherapy Waste) 31 gal
<br />31 GALLON (Regulated Medical Pethologle81 W82te) 3.1,961..,
<br />31 GALLON (Pharmaceutical Waste) 31 981
<br />43 GALLON (Regulated Medical Chemotherapy Waste) 43 gat:
<br />3 GALLON 9ulat8d Medical Pathological Waste) 43 921
<br />L J Transporter 1 is to check box if this Is a through shipment
<br />Transporter 1 Address: WM Healthcare Solutions, Inc.
<br />`w 1996 Don Lee Place Ste. C
<br />C Escondido, CA 92029
<br />Transporter 1 Acknowledgement of Recei t o -Male IRIS
<br />V
<br />~ Signature
<br />TOTALS =*
<br />Ib. or B. Transfer Facility:
<br />Volume WM Healthcare Solutions, Inc.
<br />5337 LuceAvenue, B G 2430
<br />McClellan, CA 55
<br />Phone (512)8
<br />Permit #; TS• - e. _� -441
<br />incineration Facility:
<br />17505 State Hwy 65
<br />L Anahuac, TX 77514
<br />l Phone(409)267.3913
<br />Permit #: MSW 2239-A
<br />® 7D. Autoclave Facility:
<br />Waste Management
<br />1390 E Commercial Row
<br />Reno, NV 59512
<br />Phone (776) 326-2409---�
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<br />Healthcare Solutions, Inc. ; d m m F
<br />Applicable permit numbeds: Escondido- 5688 — MW -172 4280 Bandini Blvd.
<br />i a
<br />Phone #: (760) 469-5009 Vernon, CA 90058
<br />j Phone (323) 307.0514
<br />Vernon- 5688 — MW -157 1 Permit #;TS/OST 81
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<br />Ph a #: (323) 307-0514 !Signature
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<br />A N o' �a� Date 1,© f ,� i Date
<br />I ®®CfJfUfE1V. 2962
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<br />7A. Transfer Facility:
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<br />WM Healthcare Solutions, Inc.
<br />3670 Enterprise Ave.
<br />Hayward, CA 94545
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<br />Phone (512) 356-8801
<br />TS
<br />Permit #: -96
<br />Signature
<br />2c. No of
<br />2b. Container Type Contalner
<br />31 GALLON (Regulated. Medical Chemotherapy Waste) 31 gal
<br />31 GALLON (Regulated Medical Pethologle81 W82te) 3.1,961..,
<br />31 GALLON (Pharmaceutical Waste) 31 981
<br />43 GALLON (Regulated Medical Chemotherapy Waste) 43 gat:
<br />3 GALLON 9ulat8d Medical Pathological Waste) 43 921
<br />L J Transporter 1 is to check box if this Is a through shipment
<br />Transporter 1 Address: WM Healthcare Solutions, Inc.
<br />`w 1996 Don Lee Place Ste. C
<br />C Escondido, CA 92029
<br />Transporter 1 Acknowledgement of Recei t o -Male IRIS
<br />V
<br />~ Signature
<br />TOTALS =*
<br />Ib. or B. Transfer Facility:
<br />Volume WM Healthcare Solutions, Inc.
<br />5337 LuceAvenue, B G 2430
<br />McClellan, CA 55
<br />Phone (512)8
<br />Permit #; TS• - e. _� -441
<br />incineration Facility:
<br />17505 State Hwy 65
<br />L Anahuac, TX 77514
<br />l Phone(409)267.3913
<br />Permit #: MSW 2239-A
<br />® 7D. Autoclave Facility:
<br />Waste Management
<br />1390 E Commercial Row
<br />Reno, NV 59512
<br />Phone (776) 326-2409---�
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<br />LL
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<br />2%, m
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<br />'y 0
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<br />ransfer Facility: t
<br />1°
<br />WIVI
<br />baa 0.
<br />Healthcare Solutions, Inc. ; d m m F
<br />Applicable permit numbeds: Escondido- 5688 — MW -172 4280 Bandini Blvd.
<br />i a
<br />Phone #: (760) 469-5009 Vernon, CA 90058
<br />j Phone (323) 307.0514
<br />Vernon- 5688 — MW -157 1 Permit #;TS/OST 81
<br />{
<br />I
<br />Ph a #: (323) 307-0514 !Signature
<br />^'
<br />A N o' �a� Date 1,© f ,� i Date
<br />8 N >
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<br />Print, Type am.
<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 IW
<br />rd nce it all e, nd derai regulations"
<br />Print Name
<br />5,Transporter 2 Address: Smi Systems ransportatlon Phone #: (800) 897-5571
<br />IN ;; 417 9 sbluff, NE 69361
<br />•� P.O. Box 2455, Scottsbluff, NE 69363
<br />c Intermediate Handier 2 / Acknowledgement of Receipt of Materials
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<br />= Signature Permit number:
<br />~ Print / Typed Name Date
<br />6' Discrepancy
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<br />E Comments
<br />O�
<br />OTo terminated New TD 0
<br />Alternate Facility used for incineration:
<br />Healthcare Environmental Service, Inc
<br />1420 40th St North
<br />Fargo, ND 58102
<br />701-282-7374
<br />Incinerated on; Feb 13, 2012
<br />Date
<br />
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