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' MEDICAL WASTE TRACKING DOCUMENT �11�jIII�Ilii�ll�ll SERVICE DATE; 1210312013 111 I [tit 11111 ! I 19i1 1 ff VNEZO A"oieM$11rtf r/1 MedWaste.wm.Com RoUT!✓ No. — SA203 TRUCK NUMBER Seo Generator No. 949-580024 24 -Hour Emergency Response t STOCKCON SURGERY CENTER (800) 424-9300 Stdddofl CA 95208 2U1 State Generator's ID No. (209) 955-3001 Katrina Holmes Generator's US EPA ID No. 2a. Description of Waste 2b. Container Type 20. No of Cantalnei rsl .._ r- . r I ;n ay , „ 4 Snarpo Go Inter Regu a e ca a a o)) 1A ga1 I N.D.S., 8.Z PGIi tragi cn ear 8rp6 Container ermace call waste W N.O.S., Omit drp5 0 nor sgu medical 8S e 0 9a �W� •. • ••322.0slidip,f li L' a `m • n 4 CL N C t - N.O,S., 6.2, PGII N.03., 'transporter 1 is to check box if this Is a through shipment v' I TOTALS DO=> [�I�il�lli / DOCUMENT M ❑ 7A. Transfer Facitip Cherntrec # CCN24117 WM Healthcare Solutions 3670 Enterprise Ave. Hayward, CA 94545 Phone (512) 356-8901 Permit #: TS -96 Signature Date 2d. lb. orrr,17B. Transfer Facili Volume L�S� WM Healthcare Solution 5337 Luce Avenue, BLD McClellan, CA 95652 Phone (916) 830 533 Permit #: TS -9 Signature Date {V7c. Incineration Fac Curtis Bay Energy 3200 Hawkins Point Road Baltimore, MD 21226 Phone {410)354-3228 �� astination Facility: [[ - lansfer Facility: Daniels Sharpsmart, Inc. 4144 E Therese Ave. Fresno, CA 93725 Phone(659)834-6252 Permit #: T ST 55 Signature 2_ Date /?_�!o �! •� Transporter 1 Address: WM Healthcare Solutions, Inc. Applicable permit numbsrls: Escondido- 5688 - MW -172 ❑ 7E.Incineration Facility: 1996 Don Lee Place Ste. C Phone #: (760) 489.5009 Spokane Regional Solid Waste Escondido, CA 92029 Vernon- 6688 - MW -157 2900 S. Geiger Blvd. Transp ler 1 Acknowledgement of Receipt of Materials Phone #: (323) 307-0514 spci<ane, wA 99204 Phone (509) 625-6580 l-= ` Signature .�✓� PrinUTyped Name Date Permit ft: _ ^ -- ( SWRO SWPORSWDP-001 S. Transporter 2 Address: Phone #: ( ) 7. Treatment Facility. Prirtted.Certifipation of Receipt and -Treatment "l certify that the contents -5f thb IiMed•.cdnIAIner/s have been received, treated and disposed of at one or more• of•the.;facil"ities.indicated below in accordance with all local, state, and federal regulations." Signature Permit number: Print! Typed Name Date >,.m 6, Discrepancy aE o Comments PITO terminated New TD 9 71C ❑ DEC 2 9 2013 70 ❑ )r Derek'Rurnsey 7E ❑ a 0001188566 E b (, Inc. c a� aM CL " ty m n � a � u s, Inc. Q u o m > G 243G• m s a � a � T r �a c llity: u � N O - LL �� astination Facility: [[ - lansfer Facility: Daniels Sharpsmart, Inc. 4144 E Therese Ave. Fresno, CA 93725 Phone(659)834-6252 Permit #: T ST 55 Signature 2_ Date /?_�!o �! •� Transporter 1 Address: WM Healthcare Solutions, Inc. Applicable permit numbsrls: Escondido- 5688 - MW -172 ❑ 7E.Incineration Facility: 1996 Don Lee Place Ste. C Phone #: (760) 489.5009 Spokane Regional Solid Waste Escondido, CA 92029 Vernon- 6688 - MW -157 2900 S. Geiger Blvd. Transp ler 1 Acknowledgement of Receipt of Materials Phone #: (323) 307-0514 spci<ane, wA 99204 Phone (509) 625-6580 l-= ` Signature .�✓� PrinUTyped Name Date Permit ft: _ ^ -- ( SWRO SWPORSWDP-001 S. Transporter 2 Address: Phone #: ( ) 7. Treatment Facility. Prirtted.Certifipation of Receipt and -Treatment "l certify that the contents -5f thb IiMed•.cdnIAIner/s have been received, treated and disposed of at one or more• of•the.;facil"ities.indicated below in accordance with all local, state, and federal regulations." Signature Permit number: Print! Typed Name Date >,.m 6, Discrepancy aE o Comments PITO terminated New TD 9 71C ❑ DEC 2 9 2013 70 ❑ )r Derek'Rurnsey 7E ❑ a