Laserfiche WebLink
MEDICAL WASTE TR '0140,0,0CUMENT <br />VL�zo SERVIC9.DATE: <br />WASTE MANAGEMENT ROUTE No. - TRUCK NUMBER <br />medwastemm.com- <br />DocuMENT#: <br />Sect <br />Generator No. <br />=77 <br />24 -Hour Emergency Response <br />(800)424 -9300 <br />El 7A. Transfer Facility: <br />WM Healthcare Solutions. Inc. <br />3670 Enterprise Ave. <br />J <br />Hayward, CA 94545 <br />Phone (512) 356-8901 <br />Permit #: TS -96 <br />State Generator's ID No. <br />Signature <br />Date <br />Generator's US EPA ID Na. <br />❑ 7b. Transfer Facility: <br />VVtri Healthcare Solutions, Inc, <br />2a. Description of Waste <br />2b. Container Type <br />2c. No of <br />Containers <br />2d. 1b. or <br />Volume <br />i <br />5337 Luce Avenue, BLDG 243G <br />EE e <br />McClellan, CA 95652 <br />Phone (512) 356-8907 <br />Permit #: TS -98 <br />Signature <br />A k v <br />Date <br />E] 7C. Incineration Facility: <br />WIVIRRRC <br />7505 State Hwy 65 <br />11z— Jj,*; o�� <br />re)Phone <br />AnahuacTX 77614 <br />(409) 267-3913 <br />Permit #: MSW 2239 -A <br />7D. Alternate Facility: <br />Transporter 1 Is to check box If this Is a through shipment <br />TOTALS <br />[:]-7E.-bestinatlon Facility: <br />Transporter 1 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 />Applicable permit number/s: Escondido- 5688- MW -172 <br />Phone #: (760) 489-5009 <br />Vernon- 5688 - MW -157 <br />Phone #: (323) 307-0614 <br />Signature Print / Typed Name Date <br />5, Transporter 2 Address: <br />0 <br />6, E <br />2 F® <br />Signature <br />1-- <br />Print/ Typed Name <br />6. Discrepancy <br />CL E <br />E Comments <br />0 <br />M4 0 <br />Ij To terminated New To # <br />4994F&rels'o Ave. <br />Fresno, CA 93725 <br />Phone (559) 834-6252 <br />Permit #: MOST 55 <br />Signature_ <br />Date <br />Phone lf:Treatment Facility Printed Certification of Receipt and Treatment <br />11"I certify that the contents of the listed container/s have been received, treated <br />and disposed of in accordance with all local, state, and federal regulations." <br />Print Name <br />Permit number: <br />Date <br />Signature <br />Date <br />42,0 0) <br />C Al <br />0 <br />E <br />o > <br />0 <br />0,0 <br />Z3 <br />0 0 <br />4' C <br />T v.2 .2) <br />cO E <br />c) s <br />