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MEDICAL WASTE TP" 'KING„ QCUMEIVT <br />L :t ., a <br />SERVI� ATE. <br />R®UTE No. ® TRUCK NUMBER <br />. <br />p :. <br />x: <br />ocuMENT <br />Seq Generator No. w a £ <br />24 -Hour Emergency Response <br />®7A. Transfer Facility: <br />lm <br />424-9300 <br />WM Healthcare inc. <br />I <br />a800) <br />3670Enterprise Avle�ons; <br />3=s r <br />State Generator's ID No. <br />ward, CA 94545 <br />Phone (512) 356-8901 <br />k'io etc{.i <br />Permit #:TS -96 <br />` '.e <br />Signature <br />Generator's US EPA ID No. <br />Date <br />;gyp <br />Q 7S. Transfer Facility: <br />2a. Description of Waste 2b. Container Type 2c. No of 2d. Ib. or <br />Containers Volume <br />WM Healthcare Solutions, Inc. <br />5337 Luce Avenue, BLDG 243G <br />McClellan, CA 95652 <br />i <br />Phone (512) 356.8907 <br />Permit #: TS -98 <br />Signature <br />U <br />bate <br />® 7C. Incineration Facility: <br />WMRRRC <br />7505 State Hwy 65 <br />Anahuac, TX 77514 <br />Phone (419) 267-3913 <br />Permit #: MSW 2239-A <br />7D. Autoclave Facility: <br />Waste Management <br />1390 E Commercial Row <br />Reno, NV 69512 <br />Phone (775) 326.2409 <br />Permit #: MSWL-003 <br />A WH -004 <br />4` <br />Transporter 1 is to check box if this is a through shipment <br />❑ <br />TOTALS ==> <br />®FSE. Alternate Facility: <br />Transporter 1 Address: WM Healthcare Solutions, Inc. <br />1996 Don Lee Place Ste. C <br />Escondido, CA 92029 <br />CL <br />Transporter 1 Acknowledgement of Receipt of Materials <br />12 <br />I— Signature <br />Applicable permit numbar/s: <br />Escondido- 5688 -- MW -172 <br />Phone #: (760) 489-5009 <br />Vernon- 5668 — MW -157 <br />Phone #: (323) 307-0514 <br />Print /Typed Name Date <br />5. Transporter 2 Address: Smith Systems Transportation Phone 0: (800) 897-5571 <br />417 9"' Ave, Scottsbluff, NE 69361 <br />ai P.O. Box 2455, Scottsbluff, NE 69363 <br />E c: Intermediate Handier 2 / Acknowledgement of Receipt of Materials <br />Co <br />cSignature Permit number: <br />~ _ Print/ Typed Name Date <br />v w 6 Discrepancy _ <br />�E <br />E <br />v ® Comments <br />�O <br />TD terminated New TD # <br />VJM Healthcare Solutions, Inc, <br />4280 Bandint Blvd. <br />Vernon, CA 90058, <br />Phone (323) 307.0514 <br />Permit #:TSIOST 81 <br />Signature <br />{w> Date <br />JTreatment 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 />i7'ti fifV=. - <br />Signature <br />Date <br />m <br />tEs <br />CL <br />CL <br />s <br />2V <br />t <br />CL Q E <br />oar <br />i9 = a <br />e <br />� to d <br />>, o <br />v0 <br />i, <br />rd ® ti <br />O <br />o � <br />q 2 <br />t° a i <br />c ® i, u <br />is v <br />eCo E <br />o tp 6 <br />c O <br />0 o, <br />- . <br />_ �ro <br />N u <br />O N 2 <br />10D 0) <br />0 y <br />r <br />7f; a O <br />� tis v u <br />h�� ,. o <br />iu w i? <br />0 m rory <br />c g <br />0�, <br />E . �3 <br />U 0 iii <br />a= 0 W Or <br />6 ,° <br />CJvc d 00 <br />® ch c <br />Z o 0) <br />tV E <br />>u n <br />a <br />