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JI <br />01 1 1 <br />ft 40 <br />Sect <br />Generator No. <br />k .v,. <br />24 -Hour Emergency Response <br />(800) 424-9300 <br />[-17A. Transfer Facility: <br />Healthcare Solutions, Inc. <br />A, tWM <br />3670 Enterprise Ave. <br />Hayward, CA 94545 <br />State Generator's ID No. <br />Phone(612)356-8901' <br />Permit #: TS -96 <br />Signature_ <br />Generator's US EPA ID No. <br />Date <br />2a. Description of Waste <br />2b. Container Type <br />2C. No of <br />2dor lb. . <br />7B. Transfer Facility: <br />EY" <br />Containers <br />Volume <br />WM Healthcare Solutions, Inc. <br />! —H,, <br />J <br />$337 Luce Avenue, BLDG 243G <br />McClellan, CA 95652 <br />356-8907 <br />rPhone <br />o)) <br />0 <br />(512) <br />Permit #: TS -98 <br />Signature <br />Date <br />❑ 7C. incineration Facility: <br />WMRRRC <br />State <br />7605 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 />Rerio, NV 89512 <br />Phone (775) 326-2409 <br />Permit #: MSWL-003 <br />IWH-004 <br />4.TOTALS <br />Transporter I is to check box If this Is a through shipment F-1 <br />7E. Alternate Facility: <br />!no- <br />E <br />2D E <br />0 <br />Transporter I Address: WIVI Healthcare Solutions, Inc. <br />1996 Don Lee Place Ste. C <br />Escondido, CA 92029 <br />Transporter I Acknowledgement of Receipt of Materials <br />VVIVI nuldill U41W oululfulabt mv. <br />Applicable permit numbeds: Escondido- 5688 — MW -172 4280 Bandini Blvd. <br />Signature Print /Typed Name ' <br />5. 1 Transporter 2 Address: Smith Systems Transportation Phone 0: (800) 897-5571 <br />417 9"' Ave, Scottsbluff, NE 69361 <br />P.O. Box 2455, Scottsbluff, NE 69363 <br />Intermediate Handier 2 / Acknowledgement of Receipt of Materials <br />Signature <br />Print /Typed Name <br />6. <br />Discrepancy <br />Comments <br />1:1 TI) terminated New To # <br />Permit number: <br />Date <br />Phone #: (760) 489-5009 Vernon, CA 90058 <br />Vernon- 5688 — MW -157 Pbone (323) 307-0514 <br />Phone #: (323) 307-0514 Permit #:TS/OST 81 <br />Signature <br />Date Date_ <br />Treatment Facility Printed Certification of Receipt and Treatment <br />"I certify that the contents of the listed contalneds 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 />0 <br />