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7YT�A. WWASTE INnAfUAGEIVIENT medwastemm.com ROUTE No. - MEDICAL WASTE TR ' 'KING DOCUMENT SERVICE DATE: TRUCK NUMBER t.t Ij DOCUMENT #: CL C C M 0 CL E E 0 L) Transporter 1 Address: WM Healthcare Solutions, Inc. 1996 Don Lee Place Ste. C Escondido, CA 92029 Transporter 1 Acknowledgement of Receipt of Materials Signature Applicable permit numbeds: Escondido- 5688 -MW-172 Phone #: (760) 489-5009 Vernon- 5688 - MW -157 Phone #: (323) 307-0514 Print / Typed Name —Date Transporter 2 Address: Smith Systems Transportation Phone #: (800) 897-5571 417 9th Ave, Scottsbluff, NE 69361 P.O. Box 2455, Scottsbluff, NE 69363 Intermediate Handier 2 / Acknowledgement of Receipt of Materials Signature Print /Typed Name !d Discrepancy Comments 1-1 TD terminated New To # Permit number: Date WM Healthcare Solutions Inc. 4280 Bandint Blvd, Vernon, CA 90058 Phone (323) 307-0514 Permit #*.TSIOST81 Signature Date 7. Treatment Facility Printed Certification of Receipt and Treatment "I certify that the contents of the listed container/s have been received, treated and disposed of in accordance with all local, state, and federal regulations." Print Name Signature Date E0) ro CL CL CL E e 0 T*; CL 0) 0)" 0 0 ns g ar CL 4�* 0 0 OCL 0 ccE cn -r- M 0 Z0 ami CL 0 8 co CL 75 ro 0 E o E el a 4) as CL co ro- 'u 0 U) Seq Generator No. 24 -Hour Emergency Response 07A. Transfer Facility: (800) 424-9300 WM Healthcare Solutions, Inc. T - 7 7, 77 71.". 3670 Enterprise Ave. Hayward, CA 94545 State Generator's ID No. Phone (512) 356-8901 Permit 9 -. TS -96 Signature Generator's US EPA ID No. -Date- EI 7B, Transfer Facility: 2a. Description of Waste 2b. Container Type 2c. No of 2d. lb. or Containers Volume WM Healthcare Solutions, Inc. j,�A' lk� —10L 5337 Luce Avenue, BLDG 243E McClellan, CA 95652 Phone (512) 356-8907 Permit #. TS -98 Signature 13 Date ❑ 7C. Incineration Facility; t u 7505 State Hwy 65 Anahuac, TX 77514 Phone (409) 267-3913 Permit #: MSW 2239-A [-] 7D. Autoclave Facility: Waste Management 1390 E Gommerciall Row Reno, NV 89512 Phone (775) 326-2409 Permit #:_-ASWL-003 57E, Alternate Facility: 4. shipment Transporter 1 Is to check box if this Is a through❑ TOTALS 11 CL C C M 0 CL E E 0 L) Transporter 1 Address: WM Healthcare Solutions, Inc. 1996 Don Lee Place Ste. C Escondido, CA 92029 Transporter 1 Acknowledgement of Receipt of Materials Signature Applicable permit numbeds: Escondido- 5688 -MW-172 Phone #: (760) 489-5009 Vernon- 5688 - MW -157 Phone #: (323) 307-0514 Print / Typed Name —Date Transporter 2 Address: Smith Systems Transportation Phone #: (800) 897-5571 417 9th Ave, Scottsbluff, NE 69361 P.O. Box 2455, Scottsbluff, NE 69363 Intermediate Handier 2 / Acknowledgement of Receipt of Materials Signature Print /Typed Name !d Discrepancy Comments 1-1 TD terminated New To # Permit number: Date WM Healthcare Solutions Inc. 4280 Bandint Blvd, Vernon, CA 90058 Phone (323) 307-0514 Permit #*.TSIOST81 Signature Date 7. Treatment Facility Printed Certification of Receipt and Treatment "I certify that the contents of the listed container/s have been received, treated and disposed of in accordance with all local, state, and federal regulations." Print Name Signature Date E0) ro CL CL CL E e 0 T*; CL 0) 0)" 0 0 ns g ar CL 4�* 0 0 OCL 0 ccE cn -r- M 0 Z0 ami CL 0 8 co CL 75 ro 0 E o E el a 4) as CL co ro- 'u 0 U)