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MEDICAL c DoCUMENT <br />IIhh1SERVICE <br />DATE: <br />WASTE MAIIVAGEMENT# i NUMBERTRUCK DOCUMENT A, <br />N <br />C <br />H <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 />Signature <br />VYIn nuttliffudiu uuulea, „se. <br />Aptlicable ermitnumber/s: Escondido- 5688—MW-172 9260 Bandni Blvd. <br />Print / Typed Name <br />J Transporter 2 Address: Smith Systems Transportation Phone #: (800) 897-5571 <br />417 9'h Ave, Scottsbluff, NE 69361 <br />P.O. Sox 2455, Scottsbluff, NE 69363 <br />Intermediate Handier 21 Acknowledgement of Receipt of Materials <br />Signature <br />Print 1 Typed Name _ <br />Discrepancy <br />Comments <br />1-1 TD terminated New TD If <br />Permit number: <br />Date <br />Phone #: (760) 489-5009 Vernon, CA 90056 <br />Vernon- 5688 — MW -157 Phone (323) 307.0514 <br />Phone #: (323) 307.0514 Permit CTSLOST 81 <br />Signature <br />.r <br />Date Date <br />7. Treatment Facility Printed Certification of Receipt and Treatment <br />"I certify that the contents of the listed containerls 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 />a <br />E <br />m <br />c <br />CL <br />O •tC0 O <br />Q. O 9 <br />V m ® U <br />� C <br />-2 o <br />m <br />m � 1 <br />9 o <br />� u <br />L y <br />m ,ia K <br />z7 4 <br />v� <br />1n_ <br />U C2 — <br />(0 p LL <br />C <br />to o <br />A <br />wu� C h <br />m v � <br />a <br />c <br />Call, u <br />E Q� d 1 <br />a E <br />Cd Z o <br />8 CL <br />N to C9 <br />O 9 <br />yN <br />C a, tl C C <br />C t6 C <br />0 a <br />m <br />y Cn <br />C <br />14 o <br />0 c v <br />A .Q <br />9 M � <br />Z ��' o <br />IF - <br />B E E <br />z <br />v <br />C i� <br />e <br />Coln <br />= <br />u o 0 <br />D o <br />c e <br />M 0 6 <br />W v a 0) <br />�s <br />Seq <br />Generator No. <br />,9 r, i rex t".i,:. <br />24 -Hour Emergency Response <br />❑7A. Transfer Facility: <br />(Q) -9300 <br />WM Healthcare Solutions, Inc. <br />3670EnterptiseAve. <br />Wayward, CA 94545" <br />Phone (512) 356-8901 <br />Permit #: TS -96 <br />Signature <br />Date <br />srr F=$�i�3.�:b' <br />44"'! 1 10fm P <': <br />¢r y k ## <br />State Generator's ID No. <br />Generator's US EPA ID No. <br />7D. Transfer Facility: <br />WM Healthcare Solutions, inc, <br />2a. Description of Waste <br />2b. Cent alner Type <br />2c. No of <br />Containers <br />2d. Ib. or <br />Volume <br />5337 Luce Avenue, BLDG 243G <br />McClellan, CA 95652 <br />Phone f512Y356•ti907 <br />0 =$hs�.; t <br />� .E,, i :k <br />Permit #: TS -99 <br />Signature <br />Date <br />u 7C. Incineration Facility <br />WMRHRC <br />7505 State Hwy 65 <br />Anahuac,TX 77514 <br />Phone (409) 267-3913 <br />Permit #: MSW 2239-A <br />71). Autoclave Facility: <br />Waste Management <br />1390 E Commercial Row <br />Reno, NV 89512 <br />Phone (775) 326-2409 <br />Permit #: 'MSWL•003 <br />IWH•004 <br />4' <br />Transporter 1 is to check box if this Is a through shipment <br />Alternate Facility: <br />N <br />C <br />H <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 />Signature <br />VYIn nuttliffudiu uuulea, „se. <br />Aptlicable ermitnumber/s: Escondido- 5688—MW-172 9260 Bandni Blvd. <br />Print / Typed Name <br />J Transporter 2 Address: Smith Systems Transportation Phone #: (800) 897-5571 <br />417 9'h Ave, Scottsbluff, NE 69361 <br />P.O. Sox 2455, Scottsbluff, NE 69363 <br />Intermediate Handier 21 Acknowledgement of Receipt of Materials <br />Signature <br />Print 1 Typed Name _ <br />Discrepancy <br />Comments <br />1-1 TD terminated New TD If <br />Permit number: <br />Date <br />Phone #: (760) 489-5009 Vernon, CA 90056 <br />Vernon- 5688 — MW -157 Phone (323) 307.0514 <br />Phone #: (323) 307.0514 Permit CTSLOST 81 <br />Signature <br />.r <br />Date Date <br />7. Treatment Facility Printed Certification of Receipt and Treatment <br />"I certify that the contents of the listed containerls 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 />a <br />E <br />m <br />c <br />CL <br />O •tC0 O <br />Q. O 9 <br />V m ® U <br />� C <br />-2 o <br />m <br />m � 1 <br />9 o <br />� u <br />L y <br />m ,ia K <br />z7 4 <br />v� <br />1n_ <br />U C2 — <br />(0 p LL <br />C <br />to o <br />A <br />wu� C h <br />m v � <br />a <br />c <br />Call, u <br />E Q� d 1 <br />a E <br />Cd Z o <br />8 CL <br />N to C9 <br />O 9 <br />yN <br />C a, tl C C <br />C t6 C <br />0 a <br />m <br />y Cn <br />C <br />14 o <br />0 c v <br />A .Q <br />9 M � <br />Z ��' o <br />IF - <br />B E E <br />z <br />v <br />C i� <br />e <br />Coln <br />= <br />u o 0 <br />D o <br />c e <br />M 0 6 <br />W v a 0) <br />�s <br />