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MEDICAL WASTE TRACKING DOCUMENT L3 `� <br /> vwuz. SERVICE DATE: 01187/2014 <br /> WASTE MANAGEMENT ROUTE NO.— <br /> medwaste.wmxom SA203 TRUCK NUMBER �D,OCUMENT : 0001218257 <br /> Sect Generator No. 24-Hour Emergency Response Che ec# ❑7A.Transfer Facility: W <br /> 0 1• - (800) 424-9300 CCN24117 WM Healthcare Solutions,Inc. <br /> STOCKTON SURGERY CENTER 3670 Enterprise Ave. a <br /> 8011 Cott AYE State Generator's ID No. Hayward,CA 94545 a <br /> Stocklon,CA 95209-2841 Phone(512)356-8901 2 <br /> Permit#:TS-96 o a <br /> (2OQj l"'-'00'I Generator's US EPA ID No. Signature e o 1 <br /> Katrina Hoknes Date C 4 <br /> 2a.Description of Waste 2b.Container Type 2c. No of 2d. Ib.or ® 7B,Transfer Facility: o <br /> Containers Volume <br /> p; UN3291,Regulated Medical West, S14 Sharps Container(Regulated Medical Waste(81o))14 gel WM Healthcare Solutions,Inc. <br /> ® N.O.S.,6.2,PGII 5337 Luce Avenue,BLDG 243G v ; <br /> McLellan,CA 95652 o, g <br /> �- Phamiacetttica Wash S14 Sharps Container(Pharmaceutical Waste Phone(916)830-0533 <br /> Permit#:TS-98 (-.1 v r ('1' d <br /> W UN3291,Regulated Medical Wasa, S22 Sharps Container(Regulated Medical Waste(Bio))22 gal Signature '6 <br /> Z N.O.S.,6.2 PGii Date <br /> U1 P40MA601.1110elW10 322 Sharps Container(Pharmaceutical Waste) [i27c.Incineration Facility: o <br /> Curtis Bay Energy R o <br /> Pharmeceutice! YM S32 Sharps Container(Pharmaceutical Waste)32 gel 3200 Hawkins Point Road 2, <br /> Baltimore,MD 21226 If <br /> UN3291,Regulated Medical Waste Ph ne(410)354-3228 <br /> N.O.S.,6.2,PGII S32 Sharps Container(Regulated Medical Waste(Bfo))32 gat Pe it M 2011-WMi-0036 Coe g <br /> 171 TD.Destination Facility: ccu egulate etl cal gc s Conainer e ui d MediCel Waste(BIO))32 Si Transfer Facility: eN.O.S.,6.2PGII i <br /> Daniels Sharpsmart,Inc. o a 2 0 <br /> armacs c S32 Sha s Container Pharmaceitticai Waste 32 gal 4144 E Therese Ave. <br /> ( ) g h � Fresno,CA 93725 d a <br /> .l o Phone(559)834-6252 <br /> Permit#: T /OST 5 0 m <br /> 4. Signatures�- �' c E <br /> Transporter 1 Is to check box if this is a through shipment Q TOTALS ���� Date _ — =v 5 a € <br /> Transporter 1 Address: WM Healthcare Solutions,Inc. Applicable permit numbers: Escondido-5688—MW-172 !❑ 7E.Irtcineration Facility: L�; <br /> 1996 Don Lee Place Ste.C Phone#:-(760)489-5009 m c <br /> o Escondido,CA 92029 ! Spokane Regional Solid Waste u <br /> a Vernon-5688-MW-157 2900 S.Geiger Blvd. m <br /> c Transp r 1 Acknowledgement of Receipt of Materials Phone#:(323)307-0514 ! Spokane,WA 99204 <br /> Phone(509)625-6580 o ' y <br /> ~ Signature Print/Typed Name W��` Date l Permit#: a <br /> ! SHRD SW-PORSWDP-001 m <br /> 0 c- <br /> r c <br /> 5, Transporter 2 Address: Phone M ( ) 7. Treatment Facility Printed Certification of Receipt and Treatment L C: e 1 <br /> "I certify that the contents of the listed containeds have been received, c E o <br /> treated and disposed of at one oi'vnofe of the fiacillties indicated below in r E 01 <br /> g accordance with all local,state,and federal regulati-r)S." v $ <br /> c«= Signature Permit number: Cc <br /> m C <br /> Print r Typed Name Date 7C ® . 0U &= 1 i, <br /> a <br /> 6. 70 ❑ JAN 31 20t4 y`$ ' V <br /> « Discrepancy « 2e.m c <br /> ec <br /> E 7E ❑ r Derek RU Msey c g � re, <br /> Comments <br /> M <br /> ®TD terminated New TO# ❑ <br /> J <br />