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I T 1 10 q-W-i1Yrtt-A( 0 MEDICAL WASTE TR' -,mG DOCUMENT 1- !'! , SERVICE DATE: ROUTETRUCK NUMBER ,�E DocuMENT#: �0, Transporter 1 Address: WM Healthcare Solutions, Inc. 1996 Don Lee Place Ste. C ## Escondido, CA 92029 C U) Transporter 1 Acknowledgement of Receipt of Materials I! Signature Applicable permit numbeds: Escondido- 5688 - MW -172 Phone #: (760) 489-5009 Vernon- 5688 - MW -157 Phone If. (323) 307-0514 Print/ Typed Name Date 5. ] Transporter 2 Address: Smith Systems Transportation Phone #: (800) 897-5571 N 0 417 9"' Ave, Scottsbluff, NE 69361 - 'M t ;5 2, P.O. Box 2455, Scottsbluff, NE 69363 0 lu 'a E Intermediate Handier 2 / Acknowledgement of Receipt of Materials yLro Signature Permit number: Print I Typed Name Date Discrepancy W (D CL E E ® comments FITD terminated New TD If vvm Heauncare z)otudons, mc. 4280 Bandin! Blvd. Vernon, CA 90058 Phone(323)307-0514 Permit #:TSIOST 81 Signature Date_ 7. Treatment Facility Printed Certification of Receipt and Treatment 1 certify that the contents of the listed containerls have been received, treated and disposed of in accordance with all local, state, and federal regulations." Print Name Signature Date a Sect Generator No. 24 -Hour Emergency Response [-17A. Transfer Facility: (800) 424-9300 WM Healthcare Solutions, Inc. 1. C f ? N F11 C' f- E ,,i � I "', i'x 3670 Enterprise Ave. Hay�vatd, CA 94545 State Generator's ID No. Phone(512)356.8901 Permit #: TS -96 Signature Date Generator's US EPA ID No. 2a. Description of Waste 2b. Container Typo 2c. No of 2d. lb. or 7B. Transfer Facility: Containers Volume WM Healthcare Solutions, Inc. 7 fA I 71717, ;7 i r: 5337 Luce Avenue, BLDG 2430 McClellan, CA 95652 I J!,7771 �x "I 7 771,� V- 9" Phone (512) 356-8907 Permit #: TS -98 Signature - Date E] 7C, Incineration Facility: WMRRRC State 7505 Hwy 65 Anahuac, TX 77514 Phone (409) 2617-3913 Permit #: MSW 2239-A E] 71). Autoclave Facility: Waste Management 1390 E Commercial Row Reno, NV $9512 Phone (775) 32O 2409 V Permit #: -MSWL-003 IWH-004 4. Transporter 1 Is to check box If this Is a through shipment El TOTALS " 12 712. Alternate Facility., Transporter 1 Address: WM Healthcare Solutions, Inc. 1996 Don Lee Place Ste. C ## Escondido, CA 92029 C U) Transporter 1 Acknowledgement of Receipt of Materials I! Signature Applicable permit numbeds: Escondido- 5688 - MW -172 Phone #: (760) 489-5009 Vernon- 5688 - MW -157 Phone If. (323) 307-0514 Print/ Typed Name Date 5. ] Transporter 2 Address: Smith Systems Transportation Phone #: (800) 897-5571 N 0 417 9"' Ave, Scottsbluff, NE 69361 - 'M t ;5 2, P.O. Box 2455, Scottsbluff, NE 69363 0 lu 'a E Intermediate Handier 2 / Acknowledgement of Receipt of Materials yLro Signature Permit number: Print I Typed Name Date Discrepancy W (D CL E E ® comments FITD terminated New TD If vvm Heauncare z)otudons, mc. 4280 Bandin! Blvd. Vernon, CA 90058 Phone(323)307-0514 Permit #:TSIOST 81 Signature Date_ 7. Treatment Facility Printed Certification of Receipt and Treatment 1 certify that the contents of the listed containerls have been received, treated and disposed of in accordance with all local, state, and federal regulations." Print Name Signature Date a