COMPLIANCE INFO_2012-2020 - Laserfiche WebLink

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0. WASTE MANA®EMEWT med aste. mxom MEDICAL WASTE TRACKING DOCUMENT SERVICE DATE:. 01!10!2012• ROUTE N0. -- .A.)U TRUCK NUMBER �tlr9j tit t'v iti)p� I pisttjll E►� � II1}r!; I kill ` ti i i iii. r it l ± IF V it, i , • r Y m � c •a a t N N W o :I o � m � CL a E c d & q_� ZM V y � D 0 7LCi 1— o `o Daniels Sharpsmart, Inc. i Transporter 1 Address: WM Healthcare Solutions, Inc. Applicable permit numbers: Escondido- 5688 — MW -172 i 4144 E Therese Ave. 0 1996 Don Lee Place Ste. C Phone #: (760) 489-5009 Fresno, CA 93725 Y 9 Escondido, CA 92029 Vernon- 5688 — MW -157 Phone (559) 834• m � o Permit #: TS/ m a r o C Transporter 1 Acknowledgement of Receipt of Materials Ph a #: (323) 307-0514 Signatur o Signature �y�-- Print/Typed Name Date Date m S. I Transporter 2 Address: Signature Print / Typed Name — 6. Discrepancy Comments til TD terminated New TD M Phone #: ( ) Permit number: Date 7.Treatment Facility Printed Certification of Receipt and Treatment t "I certify that the contents of the listed containeds have been received, treated e and disposed of in accordance with all local, state, and federal regulations." .2 > m Print Name 0 _ Received & Treated In accordance V n' with 25 TAC Sect. 1.136 at o Waste Management RRC, TCEQ ' aN� � MSW # 2239 A o MA'? 13 2012 Signature MikA ANarez Date Seq Generator No. 24 -Hour Emergency Response (800) 424-9300 ❑7A. Transfer Faclilty: WM EealthcarSo4 ons, Inc. 367 Enter eA A 94545 Phone (512) 356-8901 'Permit #: TS -96 Date 0 1. RER'TRACY COM&N1T1( IJ1i HOSMA .: 949.6$0001_ 1420 N,Tracy BWSignature Tra3cy, CA 05370 51 State Generator's ID No. Generator's US EPA ID Na. 7B. Transfer Facility: WM Heaftheare Solutions, Inc. Luce CA 95 ,BLDG 2a3G McClellan, iNcClefian, CA 95652 Phone(5f2)356-890 Signpe, #: re Signature -- ate —1 2a. Description of Waste '2b. Container Type 2c. No of Containers 2d. Ib. or Volume Regulated Medical Waste. N.O.S., 6.2 LIN SM 13011a (� SHARPS (Pharmaceutical Waste) 0 gal' 1 i Regulated Medical Waste, N.O.S., 6.2 UN 3291 PGII SHARPS (Pharimaceutical.Wastel) 0 gala 5 � 2 �'` 1 l � W Regulated MedlcalWaste, N O.S., 6.2 UN 3291, PGII � SHARPS (Pharmaceutical Waste) 0 gal�� ?J L J ❑ 7c. Incineration Facility WM7505 Stat Hwy 65 Anahuac, TX 77514 Phone (409) 267.3913 w Regulated Medical Wa&,N.O.S., 6.2 UN 32,91, PGU SHARPS (Pharmaceutical Waste) 0 gal :P 5 '� R " r Permit #: MSW 2239-A 70. Alternate Facility: 4- Transporter 1 Is to check box If this is a through shipment I TOTALS �� g E. Destination Facility: r Y m � c •a a t N N W o :I o � m � CL a E c d & q_� ZM V y � D 0 7LCi 1— o `o Daniels Sharpsmart, Inc. i Transporter 1 Address: WM Healthcare Solutions, Inc. Applicable permit numbers: Escondido- 5688 — MW -172 i 4144 E Therese Ave. 0 1996 Don Lee Place Ste. C Phone #: (760) 489-5009 Fresno, CA 93725 Y 9 Escondido, CA 92029 Vernon- 5688 — MW -157 Phone (559) 834• m � o Permit #: TS/ m a r o C Transporter 1 Acknowledgement of Receipt of Materials Ph a #: (323) 307-0514 Signatur o Signature �y�-- Print/Typed Name Date Date m S. I Transporter 2 Address: Signature Print / Typed Name — 6. Discrepancy Comments til TD terminated New TD M Phone #: ( ) Permit number: Date 7.Treatment Facility Printed Certification of Receipt and Treatment t "I certify that the contents of the listed containeds have been received, treated e and disposed of in accordance with all local, state, and federal regulations." .2 > m Print Name 0 _ Received & Treated In accordance V n' with 25 TAC Sect. 1.136 at o Waste Management RRC, TCEQ ' aN� � MSW # 2239 A o MA'? 13 2012 Signature MikA ANarez Date