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7 <br />, NO-, 0- <br />A � A411�1 <br />-NOUTE No. - V� -, TRUCK NumBEZ <br />DocuMENT #: <br />Seq <br />Generator No. <br />, <br />i 4J� <br />24 -Hour Emergency Response <br />(80 0)424 - 9300 <br />E]7A. Transfer Facility: <br />WM Healthcare Solutions, Inc. <br />3670 Enterprise Ave. <br />Hayward, CA 94545 <br />State Generator's ID No. <br />Phone (512) 356-8901 <br />Permit #: TS -96 <br />Signaturp— <br />Generator's US EPA ID No. <br />4- <br />Date <br />E17B. Transfer Facility: <br />2a. Description of Waste <br />2b. Container Type <br />2c. No of <br />2d. —1b. of <br />Containers <br />Volume <br />WM Healthcare Solutions, Inc. <br />5337 Luce Avenue, BLDG 243G <br />McClellan, CA 95652 <br />Phone (612) 356-8907 <br />Permit #: TS -98 <br />Signature <br />Date <br />7C. Incineration Facility: <br />WMRARC <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 />4' <br />Transporter Transporter 1 Is to check box If this Is a through shipment <br />TOTALS <br />-IWH-004 <br />EI -7E. Alternate Facility: <br />Transporter I Address-, WM Healthcare Solutions, Inc. <br />1996 Don Lee Place Ste. C <br />Escondido, CA 92029 <br />Transporter 1 Acknowledgement of Receipt of Materials <br />ILI <br />Signature <br />U <br />QE <br />E <br />0 <br />Applicable permit number/s: Escondido- 5688— MW -172 <br />Phone 4: (760) 489-5009 <br />Vernon- 5688 — MW -157 <br />Phone #: (323) 307-0514 <br />Print / Typed Name Date <br />5. 1 Transporter 2 Address: Smith Systems Transportation Phone #: (800) 897-5571 <br />417 9th Ave, Scottsbluff, NE 69361 <br />P.O. Box 2455, Scottsbluff, NE 69363 <br />Intermediate Handier 2 1 Acknowledgement of Receipt of Materials <br />Signature <br />Print /Typed Name <br />6j - <br />Discrepancy <br />Comments <br />0 To terminated New To # <br />Permit number: <br />Date <br />WM Healthcare Solutions, Ine, <br />4280 Bandini Blvd. <br />Vernon. CA 90058 <br />Phone (323) 307-0514 <br />Permit #:TS/OST 81 <br />Signature <br />Date <br />7. Treatment Facility Printed Certification of Receipt and Treatment <br />"I certify that the contents of the listed containers have been received, treated <br />and disposed of in accordance with all local, state, and federal regulations." <br />Print Name <br />Signature <br />Date <br />A <br />