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wwuze <br />W"TE MANAGEMENT <br />medWast@I.Wmxom <br />MEDICAL WASTE TRACKING DOCUMENT <br />SERVICE DATE: 01/03/2012 <br />ROUTE NO. — , TRUCK,NUMS.ER <br />Transporter 1 Address: WM Healthcare Solutions, Inc. Applicable permit number/s: Escondido- 5688 — MW -172 28 Bandini l �atn�ons, enc. <br />,. P � 4280 Bandini Blvd. <br />1996 Don Lee Place Ste. C Phone #: (760) 489-5009 Vernon, CA 90058 <br />CA 92 .9'^'"'r^ Phone (323) 307.051 <br />Escondido, Vernon- 5688 — M 7 <br />Transporter 1 Acknowledgement ia-Lftcdel t erials hone #• 23)-307- 14 Permit #:TS/OST 81 <br />Signature <br />~ Signature 1 ��' Print / Typed Name I y at � ! Date / <br />5, l Transporter 2 Address: <br />Phone #: (800) 897-5571 <br />J <br />417A- Ave L-ottsbluff, NE 69361 <br />P. 2455, Scottsbluff, NE 69363 <br />Intermediate Handler 2 / Acknowledgement of Receipt of Materials <br />Signature Permit number: <br />Print/ Typed Name Date <br />a 6. Discrepancy <br />110) <br />Comments <br />v <br />TO terminated New TO # <br />97. 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 oOrd8noe withF14]st doral regulations." <br />Print Name Arnue <br />JAN 0 9 2012 <br />Signature Date <br />Seq Generator No. _ <br />24 -Hour Emergency Response <br />❑7A. Transfer Facility: <br />1: <br />(800) 424-9300 <br />WM Healthcare Solutions, Inc. <br />STOCKTON SURGERY CENTER <br />3670 Enterprise Ave. <br />949-580024,,, <br />State Generator's ID No. <br />rd, CA 94W <br />Phone (512) 356- 901 <br />5011 Don Ave <br />Permit #: Ts -96 <br />Stoddon, CA 95200-2541Signature <br />(208) 855-3001 <br />Generator's US EPA ID No. <br />Date <br />G. Transfer Facility: <br />2a. Description of Waste 2b. Container Type 2c11 <br />. a of 2d. ib, or <br />Co t <br />t Ener <br />Volume <br />WM Healthcare Solutions, Inc. <br />Regulated Medical Waw N.0,8., 6,2 31 GALLON. (R <br />PGII <br />lated Medical Waste, (Bio)) 31 galIJN' f <br />-j ( <br />® <br />5337 Luce Avenue, BLDG 2436 <br />McClellan, CA 95652 <br />Phone (512) 356 <br />Regulated medical Wasp, Mo.S„s.2 43 GALLON (Regulated Medical Waste (aio)) 43 gal <br />Permit #: TS -9 <br />UIYY3291 PGII <br />Signature <br />l <br />❑ 7C. incineration Facility <br />lu <br />WMRRRC <br />7505 State Hwy 65 <br />Anahuac, TX 77514 <br />Phone (409) 267-3913 <br />Permit #: MSW 2239-A <br />7D. Autoclave Facility: <br />Waste Management <br />1390 E Commercial Row <br />Reno, NV 89512 <br />Phone (775) 326-2409 <br />Permit #: MSWL-003 <br />.ri84 <br />C° . Transfer Facility: <br />4.i <br />Transporter 1 is to check box if this IS a through shipment v' <br />TOTALS 00� 1 J ( <br />Transporter 1 Address: WM Healthcare Solutions, Inc. Applicable permit number/s: Escondido- 5688 — MW -172 28 Bandini l �atn�ons, enc. <br />,. P � 4280 Bandini Blvd. <br />1996 Don Lee Place Ste. C Phone #: (760) 489-5009 Vernon, CA 90058 <br />CA 92 .9'^'"'r^ Phone (323) 307.051 <br />Escondido, Vernon- 5688 — M 7 <br />Transporter 1 Acknowledgement ia-Lftcdel t erials hone #• 23)-307- 14 Permit #:TS/OST 81 <br />Signature <br />~ Signature 1 ��' Print / Typed Name I y at � ! Date / <br />5, l Transporter 2 Address: <br />Phone #: (800) 897-5571 <br />J <br />417A- Ave L-ottsbluff, NE 69361 <br />P. 2455, Scottsbluff, NE 69363 <br />Intermediate Handler 2 / Acknowledgement of Receipt of Materials <br />Signature Permit number: <br />Print/ Typed Name Date <br />a 6. Discrepancy <br />110) <br />Comments <br />v <br />TO terminated New TO # <br />97. 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 oOrd8noe withF14]st doral regulations." <br />Print Name Arnue <br />JAN 0 9 2012 <br />Signature Date <br />