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0 <br />MEDICAL. WASTERA1 KING�DOCUMENT <br />LP,Ua T <br />SERVICE DATE: I ii11DD 6 I fff $Il lliilll (11 11 <br />WASTE MANAMMENT <br />1111111111111111111111111 <br />D ENT # 0001224673 <br />B19edwaste.+wm.com <br />Transporter 1 Address: WM Healthcare Solutions, Inc. <br />I%UU I t IHV. ^ yr ac vv t KUUM <br />RUM :K <br />' <br />❑ 7A. Transfer Facility: <br />1996 Don Lee Place Ste. C <br />Seq <br />Generator No. <br />24-Hour Emergency Response <br />Escondido, CA 92629 <br />(800) 424-9300 Chemtrec # <br />Healthcare Inc. <br />c <br />L <br />1. <br />Phone#: (323) 07-0514 <br />spoke o ;; � w <br />Phon( a > o E <br />STOCKTON SURGERY CENTER <br />CCN24117 <br />WM Solutions, <br />State Generator's ID Na. <br />JAN 16 2014 <br />801 1 flan Ave <br />3670 Enterprise Ave. <br />7D ❑ <br />Stockton, GA 95200-2841 <br />Phone (sit) 356-8901 <br />Comments <br />(209) 955.3001Permit <br />#: TS -96 <br />DTo terminated New TD 0 <br />Katrina Hoht1A5 <br />Generator's US EPA ID No. <br />Signature <br />fate <br />Za. Description of Waste <br />2b. Container Type 2c. Noof <br />Containers <br />2d. lb.or <br />Volume <br />713. Transfer Facility: <br />U14329i.RequlAtedktedlcelWaele, <br />31 GALLON (Regulated Medical Waste (Bio)) 31 gal <br />jg <br />WM Healthcare Solutions, Inc. <br />0 <br />N.O.S., 6.2, PGII <br />5337 Luce Avenue, BLDG 243( <br />, CA 95652 <br />P o McClei(91 ) 830-0533 <br />11.unrs:il,ReguiateaLtearcaliNasts, <br />43 GALLON (Regulated Medical Waste (Bio))5p <br />N.O.S., 8.2, PGII <br />Permit #: TS -96 <br />Signature <br />L <br />as <br />❑ 7C. Incineration Facility: <br />Curtis <br />3200 Hay r <br />Battimora � <br />Phone (� <br />Permit g. <br />® 7D, r, t <br />❑ Ti ' <br />Daniels., IU a <br />4144E1 Z ¢ %n <br />Fresno ,i 'o m n <br />Phone (• m Q <br />S j u t% <br />Permit mitii 5 w <br />Si naturi �• r <br />d <br />4' <br />66� <br />Transporter 1 is to checkbox if this <br />box <br />is a through shipment ElIT <br />[ $ t <br />: S <br />,x <br />� G <br />v a <br />QU <br />5. Transporter 2 Address: <br />Transporter 1 Address: WM Healthcare Solutions, Inc. <br />Applicable permit number/s: Escondido- 5688 —MW -172 <br />: LY7E :V v LZ <br />1996 Don Lee Place Ste. C <br />Phone #: (760) 489-5009 <br />oke e <br />a <br />Escondido, CA 92629 <br />Vernon- 5688 —MW -157 <br />2900 <br />c <br />L <br />Transport r Acknatavtedgement of Receipt of Materials <br />Phone#: (323) 07-0514 <br />spoke o ;; � w <br />Phon( a > o E <br />~ <br />Signature <br />Print I Typed Name Date <br />Perm ¢ 2 ¢ " ° y <br />AV.-PORswur <br />JAN 16 2014 <br />SHRD uu. <br />: S <br />,x <br />� G <br />v a <br />QU <br />5. Transporter 2 Address: <br />Phone #:( ) <br />T. Treatment Facility Printed Certification of Receipt and Treatment <br />9 certify that the pntepts of the fisted container/s have been received, <br />treated and disposed of at one or mor6 of the facilities indicated below in <br />accordance with all local, state, and federal'reguiatiorts." <br />Signature <br />Permit number. <br />Print I Typed Name <br />Date <br />7C ❑ <br />JAN 16 2014 <br />6. <br />Discrepancy <br />7D ❑ <br />Te ❑ 1" Qerek Rumsey <br />!✓ <br />Comments <br />DTo terminated New TD 0 <br />�i <br />�I <br />