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• <br />0 <br />WVRZ <br />MEDICAL WASTE TRACKING DOCUMENT <br />m SERVICE DATE: 12/31/2013 <br />WASTE MANAGEMEW'r <br />nPrlwaeip-wm-cem RoUTE No. — SA203 TRUCK NUMBER <br />Sect Generator No. 1 949_580024 24 -Hour Emergency Response <br />STOCKTON SURGERY CENTER (800) 424-9300 <br />8011 Don Ave State Generator's ID No. <br />Stockton, CA 852092841 <br />(209) 955.3001 <br />FKatrina Holmes enerat©r's US EPA It} No. <br />2a. Descriptlon of Waste 2b. Container Type 20. Na of <br />Container <br />1JN332t,R99ul0tedMedleGlWA8t9. 914 Sharpe Container (P:egulated Medical Waste (13lo))14 gal <br />N.O.S., 6.4 PGII <br />pliarmacetittolmWam I S14 Sharps Container (Pharmaceutical Waste) 14 gal <br />UN3291,Regulated Medical Waste,j S22 Sharps Container (Regulated Medical Waste (Bio)) 22 gal <br />N.O.S., 5.2, PGII <br />1111111111111111111111111 <br />DocuMENTM 0001211648 <br />//� ❑ 7A. Transfer Facility: <br />Chem 4 - <br />CCN24117 WM Healthcare Solutions, Inc. <br />3670 Enterprise Ave. <br />Hayward, CA 94545 <br />Phone (512) 356-8901 <br />Permit #: TS -96 <br />Signature <br />Date <br />er(� -7B. Transfer Facility: <br />ne Q/ <br />WM Healthcare Solutions, Inc. <br />5331 Luce Avenue, 91116 243G <br />McClellan, CA 95652 <br />Phone (916) 830.0533 <br />Permit #: TS-96Lr <br />7C. Incineration Facility: <br />Curtis say Energy <br />3200 Hawkins Point Road <br />9altirnore, MD 21226 <br />Phone(410)354-3226 <br />N ti ro <br />a S Signature <br />t' r <br />Print ITyped Name <br />� .4 6. Discrepancy <br />CG <br />CL E <br />n E Comments <br />N O <br />V <br />D <br />A 11 TD terminatod Now TD # <br />Porntlt number: <br />Date <br />7C <br />70 <br />7E <br />JAN 16 201 <br />Derek Rumstey --t <br />N.O.S.. 6.2. PGII <br />---0---. --D- <br />e_stination Facility: lity: <br />(Regulated <br />a sCon er e u a e a Ca a <br />a 9a ❑Transfer Facility: <br />PGII <br />Daniels Sharpsman. Inc <br />Pl In naVn <br />Arps Container (Pharmaceutical Was <br />4144 E Therese Ave. <br />gs FreSrto, CA 93725 <br />Phone (559) 834.6252 <br />Permit 9: TSIOST 55 <br />4. <br />Transporter I is to check box <br />if this is a through shipment a <br />Signature <br />TOTALS � r Data <br />h <br />Transporter 1 Address: <br />WM Healthcare Solutions, Inc. Applicable permit numberls: Escondido- 5688 — MW -172 i ❑ 7E.rnclneration f=acility: <br />m <br />1996 Don Lee Place Ste. C <br />Phone fl: (760) 489.5409 <br />J Spokane Regional Solid Waste <br />o <br />CL <br />Escondido, CA 92029 <br />Vernon- 5688 — MW -157 1 2900 S. Geiger Blvd. <br />N <br />Transport, 1 Acknowledgement of Receipt of Materials <br />Phone i1: (323) 307-0514 l Spokane. WA 99204 <br />F <br />J f %) , Phone (509) 625-6580 <br />(� <br />' Permit is <br />Signature <br />Printf Typed Name <br />pate ! `-j('t 1 <br />SHRO SW-PORSWDP-001 <br />5, Transporter 2 Address: <br />Phone #: { ) <br />7. Treatment Facility Printed Certification of Receipt and Treatment <br />"+ d <br />`I certify that the contents of the listed contatnerls have been received, <br />n a, <br />treated and disposed of at one or more of the facilities indicated below in <br />o c <br />accordance with all local, state, and federal regulations." <br />N ti ro <br />a S Signature <br />t' r <br />Print ITyped Name <br />� .4 6. Discrepancy <br />CG <br />CL E <br />n E Comments <br />N O <br />V <br />D <br />A 11 TD terminatod Now TD # <br />Porntlt number: <br />Date <br />7C <br />70 <br />7E <br />JAN 16 201 <br />Derek Rumstey --t <br />