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4 <br />MEDICAL WASTE TRA -KING DOCUMENT <br />SERVICE DATE: <br />ROUTE No. ® <br />TRUCK NUMBER DocUMIENT' <br />E <br />rs <br />c3L <br />4) cl <br />cL CL <br />2 cis <br />CL <br />4) <br />:G <br />0 W <br />0 <br />o <br />t: <br />0 <br />cL <br />fi C <br />:3 Lo <br />O <br />8 <br />co 5 <br />CIL 80 <br />E <br />o E c' <br />(a 12 <br />Z z <br />C 0 <br />00. 0 <br />ILI <br />0 <br />tee a <br />CL M <br />a cL <br />Daniels Sharpsmart, Inc. Q <br />:5 <br />e. 0 .0 � I <br />Applicable permit numbeds: Escondido- 5688 — MW -172 4144 E Therese Ave. ED - " , I <br />!I. <br />rn <br />N 0 <br />0 <br />C <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 />Signature <br />5. Transporter 2 Address: <br />Signature <br />Print / Typed Name <br />�j Discrepancy <br />Comments <br />11 To terminated Now To # <br />Print /Typed Name <br />Phone #: ( ) <br />Permit number: <br />Date — <br />Phone #: (760) 489-5009 Fresno, CA 93726 <br />Seq <br />Generator No. <br />24 -Hour Emergency Response <br />(800) 424-9300 <br />[17A. Transfer Facility: <br />WM Healthcare Solutions, Inc. <br />3670 Enterprise Ave. <br />Hayward, CA 94545 <br />Phone(512)356•8901 <br />.2 <br />A cc: <br />J <br />State Generator's ID No. <br />Permit #: MOST 55 <br />Phone #: (323) 307-0514'0 <br />cs Q ­ <br />Permit #: TS -96 <br />C' <br />0 <br />2a. Description <br />j <br />of Waste 2b. Container Type <br />Signature_ <br />Date_ <br />Generator's US EPA ID No. <br />'�c. Na of M. —lbor <br />Containers Volume <br />f -1 7B. Transfer Facility: <br />WM Healthcare solutions, inc. <br /># <br />W ;j h!" 1)) F! <br />r <br />5337 Luce Avenue. BLDG 2430 <br />McClellan, CA 95652 <br />Phone (5 12) 356-8907 <br />C: 0) <br />7. <br />� J_11 <br />Treatment Facility Printed Certification of Receipt and Treatment <br />Permit #-. TS -90 <br />Signature <br />lu <br />fill <br />o <br />-W Ij <br />011v�,fffi,- lvv�,,-AO ;I f <br />certify that the contents of the listed container/s have been received, treated <br />e 6 E' <br />E <br />Date_ <br />7C. incineration Facility: <br />WMRRRC <br />7505 State Hwy 65 <br />and disposed of in accordance with all local, state, and federal regulations." <br />. 0 E <br />IY'0',;!;1 -�r il-A0 tl" <br />0 <br />Print Name <br />Anahuac, TX 77514 <br />E U Cc: <br />Phone (409) 267-3913 <br />Permit #. MSW 2239-A <br />71). Alternate Facility: <br />.0 <br />— <br />q <br />--77 7777,o T, <br />gg <br />i I a V 't <br />Transporter 1 Is to check box if this Is a through shipment <br />TOTALS <br />S. <br />Ej_7E. Destination Facility: <br />!I. <br />rn <br />N 0 <br />0 <br />C <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 />Signature <br />5. Transporter 2 Address: <br />Signature <br />Print / Typed Name <br />�j Discrepancy <br />Comments <br />11 To terminated Now To # <br />Print /Typed Name <br />Phone #: ( ) <br />Permit number: <br />Date — <br />Phone #: (760) 489-5009 Fresno, CA 93726 <br />19 P . <br />�0 <br />E <br />Vernon- 5688 — MW -157 Phone (559) 834-6262 <br />.2 <br />A cc: <br />Permit #: MOST 55 <br />Phone #: (323) 307-0514'0 <br />cs Q ­ <br />Signature - <br />C' <br />0 <br />Date s Date <br /># <br />Z5 0 -0 <br />r <br />C: 0) <br />7. <br />� J_11 <br />Treatment Facility Printed Certification of Receipt and Treatment <br />-g <br />certify that the contents of the listed container/s have been received, treated <br />e 6 E' <br />E <br />and disposed of in accordance with all local, state, and federal regulations." <br />. 0 E <br />Print Name <br />E U Cc: <br />.0 <br />0 <br />E <br />S. <br />X(9 <br />Signature data <br />