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4 <br />vlkf�Z(D <br />WASTE MANAGEMENT <br />orinehwast RoUTE No. <br />MEDICAL WASTE TP MRPQCUMENT <br />SERYWATE: <br />TRUCK NUMBER <br />9 4 <br />D®CUM ENT#: <br />CL <br />0 <br />C <br />co <br />C <br />CL E <br />E <br />0 <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 HealthcareSolutions. Inc. <br />Applicable permit number/s: Escondido- 5688– MW -172 4280 Bandini Blvd. <br />Print/ Typed Name 11 <br />5. Transporter 2 Address: Smith Systems Transportation Phone #: (800) 897-5571 <br />417 9 <br />1h Ave, Scottsbluff, NE 69361 <br />P.O. Box 2455, Scottsbluff, NE 69363 <br />Intermediate Handier 2 / Acknowledgement of Receipt of Materials <br />Signature <br />Print/ Typed Name <br />6.1 Discrepancy <br />comments <br />FI TD terminated Now TD 9 <br />Permit number: <br />Date <br />Phone fl: (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 />DateDate <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 />Print Name <br />Signature <br />Date <br />I LN <br />Sect, <br />Gene <br />17_.Zq <br />24 -Hour Emergency Response <br />E]7A. Transfer Facility: <br />Healthcare Solutions, Inc. <br />7 177177 i 7 77< t7,7, —"i ;7, 7o,WM <br />T <br />(800)424-9300 <br />3670 Enterprise Ave. <br />Haywaid, CA 94545 <br />State Generator's ID No. <br />Phone (512) 356-8901 <br />Permit #: TS -96 <br />pt <br />Signature <br />Generator's US EPA ID No. <br />Date <br />El 7B. Transfer Facility: <br />2c. No of <br />2d. lb. or <br />2a. Description of Waste <br />2b. Cont alner Type <br />Volume <br />I <br />Containers <br />WM Healthcare Solutions, Inc. <br />5337 Luce Avenue, 13LDG 243G <br />McClellan, CA 95652 <br />Phone(512)356-8907 <br />Permit #: TS -98 <br />Signature.Date <br />E] 7C. incineration Facility: <br />WMRRRC <br />7505 State Hwy 65 <br />Anahuac, TX 77514 <br />Phone (409) 267-3913 <br />Permit #: MSW 2239-A <br />❑ 7D. Autoclave Facility: <br />Waste Management <br />1390 E Commercial Row <br />Reno, NV 89512 <br />Phone (775) 326-2409 <br />Permit #: MSWL-003° <br />,y <br />IWH-004 <br />Transporter 1 Is to check box It this Is a through shipmentty <br />1:1 <br />TOTALS i -- - - —j"11 <br />I <br />R 7E. Alternate Facil.l . <br />CL <br />0 <br />C <br />co <br />C <br />CL E <br />E <br />0 <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 HealthcareSolutions. Inc. <br />Applicable permit number/s: Escondido- 5688– MW -172 4280 Bandini Blvd. <br />Print/ Typed Name 11 <br />5. Transporter 2 Address: Smith Systems Transportation Phone #: (800) 897-5571 <br />417 9 <br />1h Ave, Scottsbluff, NE 69361 <br />P.O. Box 2455, Scottsbluff, NE 69363 <br />Intermediate Handier 2 / Acknowledgement of Receipt of Materials <br />Signature <br />Print/ Typed Name <br />6.1 Discrepancy <br />comments <br />FI TD terminated Now TD 9 <br />Permit number: <br />Date <br />Phone fl: (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 />DateDate <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 />Print Name <br />Signature <br />Date <br />I LN <br />