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4 <br />U A& 115n. <br />SAW <br />W, <br />WASTE MAIUAGEMEM <br />I' ed,*uaate-.*,v,,w.qoiT,3m P��-JiPUTE7NO- <br />MEDICAL WASTE TRDocuMENT <br />SERMEDATE: <br />uz��[ <br />F$ToTRM�. <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 />12 <br />Signature <br />5. Transporter 2 Address: <br />N 0) <br />0 d) 13 <br />CL <br />V) <br />ff Signature <br />t - <br />Print / Typed Name — <br />:6.T Discrepancy <br />,pancy <br />Comments <br />0 TD terminated New To # <br />Daniels Sharpsmart, Inc. <br />Applicable permit number/s. Escondido- 5688—MW-172 4144 E Therese Ave. <br />Phone #: (760) 489-5009 Fresno, CA 93725 <br />Vernon- 5688 — MW -157 Phone (559) 834-6252 <br />Phone #: (323) 30Permit #: TS/OST 557-0514 Signature <br />Print I Typed Name,, Date Date_ <br />Phone 0: ( ) <br />Permit number: <br />Date <br />�Treatment Facility Printed Certification of Receipt and Treatment <br />J"l certify that the contents of the listed conlainer/s 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 />F0, <br />Seqj; <br />Generator No.,F <br />- <br />24 -Hour Emergency Response <br />424-93 <br />( 800) 00 <br />[:17A. Transfer Facility: <br />WM Healthcare Solutions, Inc. <br />3670 Enterprise Ave. <br />21. <br />Hayward, CA 94545 <br />Phone (512) 356-8901 <br />Permit #: TS -96 <br />State Generator's ID No. <br />Signature <br />Generator's US EPA ID No. <br />1)ate- <br />El 7B. Transfer Facility: <br />WM Healthcare Solutions, Inc. <br />2a. Description of Waste- <br />t % <br />2b. Fopt�,Iner'Typa' <br />2c. No of <br />Containers <br />2d. lb. or <br />Volume <br />5337 Luce Avenue, BLDG 243E <br />McClellan, CA 95652 <br />Phone(512)356-8907 <br />Permit #: TS -98 <br />Signature _— <br />Date — <br />WO A <1 <br />+ <br />LU <br />E] 7C. incineration Facility: <br />WMRRRC <br />7505 State Hwy 65 <br />ot is i I k;'t , I <br />Anahuac, TX 77514 <br />Phone (409) 267-3913 <br />-J j (I <br />Permit #: MSW 9239-A <br />Ej 70. Alternate Facility: <br />4. <br />Transporter 1 Is to check box If this Is a through shipment <br />a <br />TOTALS U C�,,T <br />EY7E. Destination Facility: <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 />12 <br />Signature <br />5. Transporter 2 Address: <br />N 0) <br />0 d) 13 <br />CL <br />V) <br />ff Signature <br />t - <br />Print / Typed Name — <br />:6.T Discrepancy <br />,pancy <br />Comments <br />0 TD terminated New To # <br />Daniels Sharpsmart, Inc. <br />Applicable permit number/s. Escondido- 5688—MW-172 4144 E Therese Ave. <br />Phone #: (760) 489-5009 Fresno, CA 93725 <br />Vernon- 5688 — MW -157 Phone (559) 834-6252 <br />Phone #: (323) 30Permit #: TS/OST 557-0514 Signature <br />Print I Typed Name,, Date Date_ <br />Phone 0: ( ) <br />Permit number: <br />Date <br />�Treatment Facility Printed Certification of Receipt and Treatment <br />J"l certify that the contents of the listed conlainer/s 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 />F0, <br />