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9 - <br />RpUTE No. <br />MEDICAL . POCUMENT <br />F <br />Y ATE: <br />ii ll 1 I� ill <br />1 <br />OCUMENT #. <br />Seq <br />Generator No. <br />24 -Hour Emergency Response <br />0 <br />(800)424-930 Q <br />®7A. Transfer Facility: <br />3670WIVI <br />f $ 1 <br />Hayward, CA 94545 <br />Phone (512) 358-8901 <br />State Generators ID No. <br />Permit #: TS -96 <br />r :' ' 10ft i <br />Signature <br />Generator's US EPA iD No. <br />Date <br />-1 78. Transfer Facility: <br />2a. Description <br />of Waste <br />2b. Container Type <br />2c. No of <br />2d. ib. or <br />a'. <br />Containers <br />Volume <br />WM Healthcare Solutions, Inc. <br />.. „ .., ..: r ,. _ <br />5337 Luce Avenue, BLDG 243G <br />McClellan, CA 95652 <br />" = <br />Phone <br />(512) 358.834 <br />Permit #: TS -98 <br />Signature ' <br />Date <br />❑ 7C. Incineration Facility: <br />t <br />WMRRRC <br />7505 State Htq 65 <br />Anahuac,TX 77514 <br />Phone (409) 267-3913 <br />Permit # MSW 2239•A <br />El 70.. Autoclave Facility: <br />Waste Management <br />1390 E Commercial Row <br />Reno, NV 89512 <br />Phone (775) 326-2409 <br />Permit #: MSWL-003 <br />1WH-004 <br />4. <br />Transporter 1 Is to check box it this Is a through shipment <br />TOTALS lJl,._-._ �� <br />❑ 7E. Alternate Facility: <br />Transporter 1 Address: WM Healthcare Solutions, Inc. Applicable permit numbers: <br />4k 1996 Don Lee Place Ste. C <br />Escondido, CA 92029 <br />cTransporter 1 Acknowledgement of Receipt of Materials <br />120 <br />H Signature Print/ Typed Name <br />5. 1 Transporter 2 Address: Smith Systems Transportation Phone #: (800) 897-5571 <br />tv d 417 91" Ave, Scottsbluff, NE 69361 <br />c4 w P.O. Sox 2455, Scottsbluff, NE 69363 <br />aE Intermediate Handler 2 / Acknowledgement of Receipt of Materials <br />de x Signature Permit number: <br />Print/ Typed Name Date <br />Discrepancy <br />cc <br />�E <br />0 Comments <br />II n <br />I i TD terminated New TD # <br />Escondido- 5688 MW -172 <br />Rhone M (760) 489-5009 <br />Vernon- 5688-- MW -157 <br />Phone #: (323) 307-0514 <br />Date <br />WM Healthcare Solutions, Inc, <br />4280 Bandini Blvd, <br />Vernon, CA 90058 <br />Phone(323)307-0514 <br />Permit #:TS/OST 81 <br />Signature <br />Date- <br />7. <br />Treatment Facility Printed Certification of Receipt and Treatment <br />I certify that the contents of the listed containerts have been received, treated <br />and disposed of in accordance with all local, state, and federal regulations." <br />Print Name <br />Signature _ Date <br />E <br />M <br />C: <br />CL <br />:E <br />u <br />u <br />o'� o <br />I : o 8 <br />4:; c: ®U <br />0 w <br />� � 1 <br />a to <br />c u <br />14L <br />D C <br />�0 <br />_o <br />U <br />U �U <br />O LL <br />'o c <br />c <br />m � c <br />o <br />a � � <br />ns <br />r <br />c ®r u <br />E E <br />�C® E` <br />' Q <br />C <br />o� <br />C 03 6 C <br />aUi 0 N <br />r <br />� V U <br />Co o <br />U O N d <br />'o c <br />Y E <br />oroE <br />E v <br />U mc0 <br />0�o CO, <br />c <br />QUO rS <br />c a <br />C 63 <br />moo <br />an <br />m <br />