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L 9 F MEDICAL WASTE TRf QIli cUMENT HINE511 "Hul V1 R2 0 SERYIPE, PATE: WVASTE IVIIANAGEMEPUIT Uf420j medwastemm.com, RPUTE No. - TRUCK NUMBER DocuMENT !Is 0 M c I T.S CLE 4) E 00 Transporter I Address: WM Healthcare Solutions, Inc. 1996 Don Lee Place Ste. C Escondido, CA 92029 Transporter 1 Acknowledgement of Receipt of Materials Signature wm Applicable permit number/s: Escondido- 5688—MW-172 428Healthcare Sohinons, in, 0 Bandini Blvd, Phone #: (760) 489-5009 Vernon, CA 90058 Vernon- 5688 — MW -157 Phone (323)'307.0514 Phone #: (323) 307-0514 Permit #,.TS/OST 81 Signature Print /Typed Name Date! Date 5, 1 Transporter 2 Address: Smith Systems Transportation Phone #: (800) 897-5571 417 V' Ave, Scottsbluff, NE 69361 P.O. Box 2455, Scottsbluff, NE 69363 Intermediate Handler 2 / Acknowledgement of Receipt of Materials Signature Print/ Typed Name Discrepancy Comments FITD terminated Now To It Permit number: Date 7. Treatment Facility Printed Certification of Receipt and Treatiner "I certify that the contents of the listed container/s have been received, trea and disposed of in accordance with all local, state, and federal regulations." Print Name - - Signature Date I— Seq, Generator No. 24 -Hour Emergency Response E17A. Transfer Facility: (800) 424-9300 WM Healthcare Solutions, Inc. 3670 Enterprise Ave. !'X State Generator's ID No. Hayward, CA 94545 Phone (512) 356-8901 fl4, Permit #: TS -96 1! tr'j Signature Generator's US EPA ID No. Date. 2a. Description of Waste 2b. Container Type 2C. No of 2d. lb. or ❑ 7B. Transfer actilty; Containers Volume t 7 T - i I- WM Healthcare Solutions, Inc. 5337 Luce Avenue, BLDG 243( McClellan, CA 95652 Phone (512) 356-8907 I �ij Permit #; TS -98 Signature_ Date t 7C. Incineration Fac WMRRRC 7505 Slate Hwy 65 Anahuac, TX 77514 Phone (409) 267-3913 Permit #: MSW 2239-A 7D. Autoclave Facill- Waste Management 1390 E Commercial Row Reno, NV 89512 Phone (775) 326-2409 Permit #: MSWL-003 4. Transporter 1 Is to check box if this Is a through shipment F fill IWH-004 7E. Alternate Facllltj !Is 0 M c I T.S CLE 4) E 00 Transporter I Address: WM Healthcare Solutions, Inc. 1996 Don Lee Place Ste. C Escondido, CA 92029 Transporter 1 Acknowledgement of Receipt of Materials Signature wm Applicable permit number/s: Escondido- 5688—MW-172 428Healthcare Sohinons, in, 0 Bandini Blvd, Phone #: (760) 489-5009 Vernon, CA 90058 Vernon- 5688 — MW -157 Phone (323)'307.0514 Phone #: (323) 307-0514 Permit #,.TS/OST 81 Signature Print /Typed Name Date! Date 5, 1 Transporter 2 Address: Smith Systems Transportation Phone #: (800) 897-5571 417 V' Ave, Scottsbluff, NE 69361 P.O. Box 2455, Scottsbluff, NE 69363 Intermediate Handler 2 / Acknowledgement of Receipt of Materials Signature Print/ Typed Name Discrepancy Comments FITD terminated Now To It Permit number: Date 7. Treatment Facility Printed Certification of Receipt and Treatiner "I certify that the contents of the listed container/s have been received, trea and disposed of in accordance with all local, state, and federal regulations." Print Name - - Signature Date I—