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WASTE MANAGEMENT <br />MEDICAL 3 <br />SERVICE <br />SN203 TRUCK NUMBER <br />i 5 <br />tib <br />DocuMENT #: <br />Transporter 1 Address: WM Healthcare Solutions, Inc. Applicable permit number/s: Escondido- 5688 — MW -172 4280 Bandin Bl dur�`f�f��` III, - <br />Transporter 4250 8andini Blvd. <br />Sea <br />Generator No. <br />c Transporter 1 Acknowledgement of Receipt of Materials Phone #: (323) 307-0514 Permit #t:TStoST 81 <br />24 -Hour Emergency Response <br />07A. Transfer Facility: <br />( 00) 424-9300 <br />Why Healthcare Solutions, inc. <br />N' <br />44 .4r,'a .r 1.-°e a r b: , t = . <br />"1 certify that the contents of the listed container/s have been received, treated <br />d <br /># _ <br />l <br />3670 Enterprise Ave.. <br />Intermediate Handier 21 Acknowledgement of Receipt of Materials <br />Print Name <br />e (D s <br />C <br />Hayward, CA 94545 <br />t® <br />Print / Typed Name Date <br />State Generator's ID No. <br />Phone (512) 356.8901 <br />v4 <br />Discrepancy <br />Permit #: TS 96 <br />CL <br />Signature <br />L E <br />v o <br />Comments <br />Generator's US EPA ID No. <br />..:Date <br />8 <br /># <br />Signature Date <br />2c. No of <br />2d. ib, or <br />❑ 7B. Transfer Facility: <br />2a. Description of Waste <br />2b. Container Type <br />Containers <br />Volume <br />WM Healthcare Solutions, Inc. <br />77 <'tls ; 1-, <br />.1 t € <br />5337 Luce Avenue, BLDG 243G <br />McClellan, CA 95652 <br />Phone(612)356.8907 <br />.a? r it „.ri `,. <br />Permit N: TS -98 <br />Signature <br />j <br />Date <br />Q 7C. incineration Facility: <br />WMRRRG <br />7505 State 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 />Reno, NV 89512 <br />Phone (775) 326-2409 <br />Permit #: MSWL-003 <br />IWH-004 <br />4.7E, <br />i is to check box If this is a through shipment F-1TOTALS, <br />h <br />®7E. Alternate Facility: <br />Transporter 1 Address: WM Healthcare Solutions, Inc. Applicable permit number/s: Escondido- 5688 — MW -172 4280 Bandin Bl dur�`f�f��` III, - <br />Transporter 4250 8andini Blvd. <br />1996 Don Lee Place Ste. C Phone #: (760) 489-5009 Vernon, CA 90058 <br />WE <br />Escondido, CA 92029 Vernon- 5688 — MW -157 Phone (323) 307-05 14 <br />c Transporter 1 Acknowledgement of Receipt of Materials Phone #: (323) 307-0514 Permit #t:TStoST 81 <br />Signature <br />~ Signature Print / Typed Name Date Date <br />5. 1 Transporter 2 Address: Smith Systems Transportation Phone #: (800) 897-55717. <br />Treatment Facility Printed Certification of Receipt and Treatment <br />N' <br />417 9r1' Ave, Scottsbluff, NE 69361 <br />"1 certify that the contents of the listed container/s have been received, treated <br />d <br />P.O. Box 2455, Scottsbluff, NE 69363 <br />and disposed of in accordance with all local, state, and federal regulations." <br />o E c <br />Intermediate Handier 21 Acknowledgement of Receipt of Materials <br />Print Name <br />e (D s <br />C <br />Signature Permit number: <br />t® <br />Print / Typed Name Date <br />6' <br />v4 <br />Discrepancy <br />CL <br />L E <br />v o <br />Comments <br />N_ U <br />8 <br />TO terminated New To 0 <br />Signature Date <br />E <br />re <br />OF <br />a� <br />t <br />2 m a <br />CL o °3 <br />rere, BU <br />c <br />ur v c <br />0 0 <br />zs 'a <br />� u <br />O <br />n c <br />CA <br />>- 0 <br />0 N <br />C: <br />U � s <br />�" <br />reo <br />a c a <br />e <br />re ® v <br />C <br />o r <br />q U i <br />N G <br />c � <br />E n_ (0 Qi c <br />a c •o <br />r <br />URt roc <br />V <br />ns� h•� <br />•� � C LL <br />r <br />v <br />re Qc <br />-ovo <br />4 <br />re E 4 <br />ea <br />E i <br />Y <br />rn_ v <br />C a <br />� re O F <br />0. 2 <br />-0 ti <br />c a <br />w <br />0 M —_re � 'u � <br />`vo t71 <br />E <br />d vc w <br />(Srec <br />E <br />