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4 <br />MEDICAL WASTE TF, XING DOCUMENT <br />SERVICE DATE: <br />'�I'OUTE No. — TRUCK NUMBER <br />jk !i <br />DOCUMENTJ!t <br />. V.- . <br />!I. <br />rn <br />Transporter 1 Address: WM Healthcare Solutions, Inc. <br />1996 Don Lee Place Ste, C <br />Escondido, CA 92029 <br />Transporter I Acknowledgement of Receipt of Materials <br />Signature <br />Sect <br />Generator Na. <br />24 -Hour Emergency Response <br />E17A. Transfer Facility: <br />(800) 424-9300 <br />WM Healthcare Solutions, Inc, <br />0 <br />Signature <br />Print / Tvned Name <br />3670 Enterprise Ave, <br />Hayward, CA 94545 <br />State Generator's ID No. <br />Phone(512)$56.8901 <br />Permit #: TS -96 <br />Signature_ <br />�1 1 <br />�f <br />t. 1 7, } <br />[Generator's US EPA ID No. <br />Date- <br />-it-, <br />I <br />7B. Transfer Facility: <br />2a. Description of Waste <br />2b. Container Type <br />-ic- No of <br />-Fd. Ib.orE] <br />Containers <br />volume <br />Healthcare Solutions, Inc. <br />io <br />WM <br />5337 Luce Avenue, BLDG 243G <br />McClellan, CA 95652 <br />Phone {512}356.89p7 <br />Permit 0: TS -98 <br />Signature_ <br />!77777777 7, <br />li" t4e woo <br />Data_ <br />'utt"ll 1777, 77tlil J 0 . �fij-o 17 <br />7C. Incineration Facility: <br />WMRRRC <br />7606 State Hwy 65 <br />77614 <br />Phone <br />4 1�,!, <br />(4'a) <br />Phone (409) 267-3913 <br />Permit 4: MSW 2239-A <br />710. Alternate Facility; <br />Transporter 1 Is to check box If this Is a through shipment <br />TOTALS [El <br />E57E. Destination Facility: <br />!I. <br />rn <br />Transporter 1 Address: WM Healthcare Solutions, Inc. <br />1996 Don Lee Place Ste, C <br />Escondido, CA 92029 <br />Transporter I Acknowledgement of Receipt of Materials <br />Signature <br />Discrepancy <br />Comments <br />RTO terminated New To # <br />Applicable permit numbeds: Escondido- 5688 — MW -172 4144 E Therese Ave. <br />Phone #: (760) 489-5009 Fresno, CA 93725 <br />Vernon- 6688 — MW -157 Phone (559) 834-6262 <br />Phone #: (323) 307-0514 Permit M: TSIOST 55 <br />Signature_ <br />Print/Typed Name Date Date_ <br />Phone fl: 7. 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 of In accordance with all local, state, and federal regulations." <br />Print Name <br />Permit number: <br />Date <br />Signature <br />Date <br />5. j Transporter 2 Address: <br />;a N <br />0 013 <br />CL <br />0 <br />Signature <br />Print / Tvned Name <br />Discrepancy <br />Comments <br />RTO terminated New To # <br />Applicable permit numbeds: Escondido- 5688 — MW -172 4144 E Therese Ave. <br />Phone #: (760) 489-5009 Fresno, CA 93725 <br />Vernon- 6688 — MW -157 Phone (559) 834-6262 <br />Phone #: (323) 307-0514 Permit M: TSIOST 55 <br />Signature_ <br />Print/Typed Name Date Date_ <br />Phone fl: 7. 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 of In accordance with all local, state, and federal regulations." <br />Print Name <br />Permit number: <br />Date <br />Signature <br />Date <br />