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Transporter I Address: WM Healthcare Solutions, Inc. Applicable permit number/s: Escondido- 5688–MW-172 <br />1996 Don Lee Place Ste. C Phone #: (760) 489-5009 <br />Escondido, CA 92029 <br />Vernon- 5688 – MW -157 <br />Transporter 1 Acknowledgement of Receipt of Materials Phone #: (323) 307-0514 <br />Signature Print/TypedName —Date - <br />Seq; <br />Generator No. <br />C%I 0) <br />W'M <br />24 -Hour Emergency Response <br />F17A. Transfer Facility. <br />(800)424-9300 <br />WM Healthcare Solutions. Inc. <br />E =M <br />(D <br />Signature <br />3670 Enterprise Ave. <br />Print/ Typed Name <br />Hayward, CA 94545 <br />Phone (512) 356-8901 <br />State Generator's ID No. <br />W <br />Permit #: TS -96 <br />ou i <br />Signature_ <br />Generator's US EPA ID No. <br />gate <br />Lj 7B. Transfer Facility: <br />2a. Description of Waste <br />2b. Container Type <br />2c. No of <br />L <br />Containers <br />Volume <br />WM Healthcare Solutions, Inc. <br />5337 Luce Avenue, BLDG 243G <br />j <br />McClellan, CA 95652 <br />Phone(512)356.8907 <br />Permit #; TS -98 <br />Signature <br />Date <br />7C. Incineration Facility; <br />WMRRRC <br />7505 State Hvq 65 <br />TX 77514 <br />,atI l,Anahuac, <br />Phone(409)267-3913 <br />Permit #: MSW V39 -A <br />7D. Alternate Facility: <br />Transporter I Is to check box If this is a through shipment F1 <br />TOTALS ME - <br />Transporter I Address: WM Healthcare Solutions, Inc. Applicable permit number/s: Escondido- 5688–MW-172 <br />1996 Don Lee Place Ste. C Phone #: (760) 489-5009 <br />Escondido, CA 92029 <br />Vernon- 5688 – MW -157 <br />Transporter 1 Acknowledgement of Receipt of Materials Phone #: (323) 307-0514 <br />Signature Print/TypedName —Date - <br />Discrepancy <br />C <br />E <br />M 0) <br />Q <br />E 0 Comments <br />00 <br />Phone #: ( ) <br />Permit number: <br />Date <br />Daniels Shafpsmart, Inc. <br />4144 E Therese Ave. <br />Fresno, CA 93725 <br />Phone (559) 834-6252 <br />Permit #: TS/OST 55 <br />Signature_ <br />Date <br />7. ITreatment Facility Printed Certification of Receipt and Treatment <br />"I certify that the contents of the listed containerls have been received, treated <br />and disposed of in accordance with all local, state, and federal regulations." <br />Print Name <br />0 FITO terminated New TO # I I Signature Date <br />5. <br />1 Transporter 2 Address: <br />C%I 0) <br />W'M <br />t� <br />2:a <br />0 <br />Q. E <br />E =M <br />(D <br />Signature <br />Print/ Typed Name <br />Discrepancy <br />C <br />E <br />M 0) <br />Q <br />E 0 Comments <br />00 <br />Phone #: ( ) <br />Permit number: <br />Date <br />Daniels Shafpsmart, Inc. <br />4144 E Therese Ave. <br />Fresno, CA 93725 <br />Phone (559) 834-6252 <br />Permit #: TS/OST 55 <br />Signature_ <br />Date <br />7. ITreatment Facility Printed Certification of Receipt and Treatment <br />"I certify that the contents of the listed containerls have been received, treated <br />and disposed of in accordance with all local, state, and federal regulations." <br />Print Name <br />0 FITO terminated New TO # I I Signature Date <br />