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M10
<br />MEDICAL WASTE TRI —lNG�RQCUME
<br />SER r%? ATE: X I
<br />-10UTE No. - TRUCK NUMBER
<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 />WM Healthcare Solutions, Inc.
<br />Applicable permit number/s: Escondido- 5688 –MW -172 .4280 Bandini Blvd.
<br />Print! Typed Name
<br />5. 1 Transporter 2 Address: Smith Systems Transportation Phone #: (800) 897-5571
<br />417 9`h Ave, Scottsbluff, NE 69361
<br />P.O. Box 2455, Scottsbluff, NE 69363
<br />Intermediate Handler 2 Or Acknowledgement of Receipt of Materials
<br />Signature
<br />Print I Typed Name
<br />Discrepancy
<br />M (D
<br />CL E
<br />E
<br />0 0 Comments
<br />0
<br />is OTD terminated Now TD #
<br />Permit number:
<br />Date
<br />Phone #: (760) 489-5009 Vernon, CA 90058
<br />Vernon- 5688 - MW -157 Phone (323) 307-0514
<br />Phone #: (323) 307-0514 Permit #-TS/OST 81
<br />Signature
<br />Date Date
<br />7, Treatment Facility Printed Certification of Receipt and Treatment
<br />—1"l certify that the contents of the listed containers have been received, treated
<br />and disposed of in accordance with all local, state, and federal regulations."
<br />Print Name
<br />Sianalure Date
<br />Seq_
<br />Generator No.
<br />V.
<br />j
<br />424-9300
<br />DOCUMENT #.
<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 />WM Healthcare Solutions, Inc.
<br />Applicable permit number/s: Escondido- 5688 –MW -172 .4280 Bandini Blvd.
<br />Print! Typed Name
<br />5. 1 Transporter 2 Address: Smith Systems Transportation Phone #: (800) 897-5571
<br />417 9`h Ave, Scottsbluff, NE 69361
<br />P.O. Box 2455, Scottsbluff, NE 69363
<br />Intermediate Handler 2 Or Acknowledgement of Receipt of Materials
<br />Signature
<br />Print I Typed Name
<br />Discrepancy
<br />M (D
<br />CL E
<br />E
<br />0 0 Comments
<br />0
<br />is OTD terminated Now TD #
<br />Permit number:
<br />Date
<br />Phone #: (760) 489-5009 Vernon, CA 90058
<br />Vernon- 5688 - MW -157 Phone (323) 307-0514
<br />Phone #: (323) 307-0514 Permit #-TS/OST 81
<br />Signature
<br />Date Date
<br />7, Treatment Facility Printed Certification of Receipt and Treatment
<br />—1"l certify that the contents of the listed containers have been received, treated
<br />and disposed of in accordance with all local, state, and federal regulations."
<br />Print Name
<br />Sianalure Date
<br />Seq_
<br />Generator No.
<br />24 -Hour Emergency Response
<br />7A. Transfer Facility:
<br />424-9300
<br />WM Healthcare Solutions, too.
<br />t,117.77 1 171-4 1377 —k.77 1 7 7
<br />21-(800)
<br />3670 Enterprise Ave,
<br />State Generator's ID No.
<br />Hayward, CA 94545
<br />Phone (512) 356-8901
<br />�o v�4
<br />Permit #: TS -96
<br />Signature
<br />Generator's US EPA ID No.
<br />tate,
<br />El '7113. Transfer Facility:
<br />2a. Description of Waste
<br />2b. Container Type
<br />2c. No of
<br />2d. lb. or
<br />Containers
<br />Volume
<br />WM Healthcare Solutions, Inc.
<br />5337 Luce Avenue, BLDG 243G
<br />McClellan, CA 95652
<br />4
<br />Phone (512) 356,8907
<br />Permit OV, TS -96
<br />Signature
<br />Date
<br />7C. Incineration Facility:
<br />WIMRRRC
<br />7505 State Hwy 65
<br />Anahuac,TX 77514
<br />Phone (409) 267-3913
<br />Permit OV: MSW 2239-A
<br />E] 7D. Autoclave, Facility:
<br />Waste Management
<br />1390 E Commercial Row
<br />Reno, NV 89512
<br />Phone (775) 326-2409
<br />Permit OV: MSWL-003
<br />IWH-004
<br />Transporter I Is to check box if this is a through shipment
<br />7E,Alterniate 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 />WM Healthcare Solutions, Inc.
<br />Applicable permit number/s: Escondido- 5688 –MW -172 .4280 Bandini Blvd.
<br />Print! Typed Name
<br />5. 1 Transporter 2 Address: Smith Systems Transportation Phone #: (800) 897-5571
<br />417 9`h Ave, Scottsbluff, NE 69361
<br />P.O. Box 2455, Scottsbluff, NE 69363
<br />Intermediate Handler 2 Or Acknowledgement of Receipt of Materials
<br />Signature
<br />Print I Typed Name
<br />Discrepancy
<br />M (D
<br />CL E
<br />E
<br />0 0 Comments
<br />0
<br />is OTD terminated Now TD #
<br />Permit number:
<br />Date
<br />Phone #: (760) 489-5009 Vernon, CA 90058
<br />Vernon- 5688 - MW -157 Phone (323) 307-0514
<br />Phone #: (323) 307-0514 Permit #-TS/OST 81
<br />Signature
<br />Date Date
<br />7, Treatment Facility Printed Certification of Receipt and Treatment
<br />—1"l certify that the contents of the listed containers have been received, treated
<br />and disposed of in accordance with all local, state, and federal regulations."
<br />Print Name
<br />Sianalure Date
<br />
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