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4 <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 />5. 1 Transporter 2 Address: <br />Signature <br />Print/ Typed Name - <br />jDiscrepancy <br />Comments <br />FITI) terminated Now To # <br />Applicable permit number/s: <br />Escondido- 5686 - MW -172 <br />Phone #: (760) 489-5009 <br />Vernon- 6688 - MW -157 <br />Phone #: (323)307-0514 <br />pamels 1311arpsman, Inc. <br />4144 ETherese, Ave, <br />Fresno, CA 93725 <br />Phone (659)634-6262 <br />Permit #: TS/OST55 <br />Signature <br />Print/TypedName Date Date <br />Phone #: ( ) <br />Permit number: <br />Date <br />7.ITreatment 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 />1017111111t <br />Signature <br />Date <br />E0) <br />CL.T <br />.9 <br />W <br />Seq <br />Generator Na] <br />24 -Hour Emergency Response <br />E17A. Transfer Facility: <br />(804- <br />0) 429300 <br />WMHealthcare Solutions, Inc. <br />Y <br />3670 Enterprise Ave. <br />Hayward, CA 94546 <br />State Generator's ID Na. <br />Phone (512)356.3901 <br />y <br />Permit #: TS -96 <br />Signature_ <br />Generator's US EPA ID No. <br />Date_ <br />0 7B, Transfer Facility: <br />2a. Description of Waste <br />2b. Container Type <br />2c. No of <br />2d. 1b. or <br />Containers <br />Volume <br />Healthcare Solutions, Inc. <br />= II q , J, +"0 <br />WM <br />6337 Luce Avenue, BLDG 243G <br />14 sjj�: f I I <br />I <br />McClellan, CA 95652 <br />Phone (512) 356-8907 <br />Permit #: TS -98 <br />!!.771 �777 -17,1 !-7 <br />Signature <br />Date_ <br />4, <br />On. incineration Facility: <br />-IV;'-, no <br />"o0c, ',12 ow!" <br />N le, 141r�O :42 �1-1 <br />WMRRRO <br />7505 State Hwy 65 <br />Anahuac, TX 77514 <br />it 1; '�i <br />Phone(409)267-3913 <br />Permit #: MSW 2239-A <br />E] 7D. Alternate Facility - <br />Transporter I is to check box If this Is a through shipment <br />TOTALS <br />7E. Destination Facility: <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 />5. 1 Transporter 2 Address: <br />Signature <br />Print/ Typed Name - <br />jDiscrepancy <br />Comments <br />FITI) terminated Now To # <br />Applicable permit number/s: <br />Escondido- 5686 - MW -172 <br />Phone #: (760) 489-5009 <br />Vernon- 6688 - MW -157 <br />Phone #: (323)307-0514 <br />pamels 1311arpsman, Inc. <br />4144 ETherese, Ave, <br />Fresno, CA 93725 <br />Phone (659)634-6262 <br />Permit #: TS/OST55 <br />Signature <br />Print/TypedName Date Date <br />Phone #: ( ) <br />Permit number: <br />Date <br />7.ITreatment 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 />1017111111t <br />Signature <br />Date <br />E0) <br />CL.T <br />.9 <br />W <br />