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MEDICAL WASTE TRACKING DOCUMENT �i 72 �� �� <br /> ® SERVICE DATE: 01/14/2014 ( I{ e �� � � � 111111, <br /> WASTE MANAGEMENT <br /> medwaste.wm.com ROUTE NO.— X203 TRUCK NUMBER DOCUMENT M 0001224667 <br /> Seo Generator No. 949-580024 24-Hour Emergency Response ®7A.Transfer Facility: <br /> Chemtrec # <br /> 1 STOCKTON SURGERY CENTER (800) 424-9300 CCN24117 WM Healthcare Solutions,Inc. I -� <br /> 8011 Don AVe3670 Enterprise Ave. <br /> Staicitt�n GA 95209 2841 State Generators ID No. Hayward,CA 94545 N <br /> Phone(512)356-8901 s <br /> (209)955.3001 Permit M.TS-96 n a ' E <br /> Katrina Fio>ines Generator's US EPA ID No. Signature j a o r <br /> Pa to P 0 v <br /> 2a.Description of Waste 2b.Container Type 2c. No of 2d. ib.or 713.Transfer Facility: a c <br /> Containers Volume i u c <br /> QN11 i,RegulatedMadif8lWe613, S14 Sharps Container(Regulated Medical Waste(Eio)) 14 gal WM Healthcare Solutions,Inc. <br /> ® N.O.S.,6.2,PGII 5337 Luce Avenue,BLDG 243G; v r <br /> ® CL <br /> Mllelian,CA 95652 n r <br /> F PharmaceuticalWaSC3 S14 Sharps Container(Pharmaceutical Waste 1 al d Phone(916)830-0533 N i -e, <br /> Permit M TS-9@� a s S a <br /> Regulated Medical waM S22 Sharps Container(Regulated Medical Waste(Bio))22 gal Signature a \V9 <br /> W N.O.S.,6.2,PGII ate m H <br /> c y <br /> Z 1.ttffNGNU L9CL' u <br /> W 2 Sharps Container(Pharmaceutical Wast"2 27 ( 7C.Incineration Facility: ,� oLe <br /> LL <br /> Curtis Bay Energy m 2 ,� �, <br /> r. la ca rax,eS32 Sharps Container(Pharmaceutical Waste) 90+ 3200 Hawkins Point Road -'''o to <br /> Baltimore,MD 21226 0 <br /> crew , z alt e a a arpS 0 Iner egalatea Iti1edicaI waste(t110 d' got Phone(410}354-3228 a <br /> N.Q. 5.2 PGII Pergnit#:2011-WMI-0036 `c ; u <br /> m <br /> a ua,vu,�W,wwo� 7D.Destination Facility: c o E c <br /> W ribtps un dins ( e is eu M1 blue lis u mar-90- m c._ e <br /> N.O.S.,6.2 PCill <br /> ❑Transfer Facility: <br /> 0152` Z <br /> Daniels Sharpsmart,Inc. <br /> 4144 E Therese Ave. S a m d <br /> C7rP9 CUrIMMU(Pi1iU KelRical Waste m y Q <br /> Fresno,CA 93725 <br /> Phone(559)834-6252 o m w h <br /> Permit#: SlOST 5 y ro <br /> 4. L'.�! Signature -- iu T c <br /> Transporter 1 is to check box if this is a through shipment TOTALS 00� i p _ c v 5 Q- E <br /> Z a Transporter 1 Address: WM Healthcare Solutions,Inc. Applicable permit number/s: Escondido-5688-MW-172 LJ 7E.Incineration Facility: <br /> 1996 Don Lee Place Ste.C Phone M(760)489-5009 v <br /> o Escondido,CA 92029pokane Regional Solid Waste 21-0 <br /> Q. Vernon-V 5688-MW-157 i 2900 S.Geiger Blvd. mag <br /> c Transp rt 1 Acknowledgement of Receipt of Materials Phone# (323)307 0514 I Spokane,WA s92oa �.a o <br /> 1 Phone(509)625-6580 % c m <br /> Signature Print/Typed Name4 D)&- ate- - I Permit#: D @ s <br /> SHRD SW-PORSWDP-001 m v 0 <br /> 5. Transporter 2 Address: Phone#: ( ) 7. Treatment Facility Printed Certification of Receipt and Treatment L <br /> N °I certify t" the concepts-pf the' listed �ontaineds*,have been received, c� o <br /> treated and posed-df a kbr •ot`,rribrl `of <br /> facilities indicated below in e <br /> E E <br /> ° E accordance wi all local,state,andfelerakegufatigg. <br /> i < <br /> w«= Signature Permit number: ' 02o <br /> E' c <br /> Print/Typed Name Date 7C ❑ tJ <br /> Ci c a <br /> A 6. <br /> Discrepancy 7D ❑ FEB a " 20% yes ` <br /> Ul_ <br /> V p y '0 f0 C C Tj <br /> C C <br /> U.0 tT <br /> o.E. 7E ❑ Derek Rurnsey e W E N <br /> as <br /> G V Comments <br /> eo <br /> o TO terminated New TO# � ❑ <br />