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Regulated Medical Waste <br /> PagffRAcWNGDOCUMENT# 7201450 <br /> UN3291, Regulated Medical Waste, n.o.s., 6.2, PGII 2277 CODE AREA <br /> I W E <br /> "> >, SYSTEMS <br /> kr% <br /> COMPANY NAME TELEPHONE NUMBER <br /> CHCF-California Heath Care Facility (209) 467-4661 <br /> ADDRESS <br /> cr <br /> p 7707 S. Austin Rd Stockton, CA 95215 <br /> wI certify that the information provided is true and correct, and that the generated materials are properly classified, described, <br /> z packaged, labeled/placarded; and are in proper condition for transportation according to the applicable regulations of the <br /> U-i U.S. Department of Transportation. //G�fJ/� <br /> Able G. ( V 08-15-2024 1:49 PM <br /> NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> NAME(S) OF PERSONS COLLECTING, TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER <br /> Anthony Jenkins AJ 5039 <br /> COMPANY NAME TELEPHONE NUMBER <br /> w Med-Waste Systems, LLC (818) 998-5533 <br /> 1- <br /> ADDRESS DATE MEDICAL WASTE COLLECTED <br /> a <br /> 4882 McGrath St Suite 320 Ventura, CA 93003 08-15-2024 1:49 PM <br /> z Bio 44 gallon Pharm waste 8 gallon Pharm waste 3 Gal Bio 38 gallon <br /> p coot. w6 Y Y coot. vA.p p cont. wt.# I Cont. wt.p p wnt. wt.p <br /> Cr 217 4 4 53 1 4 12 727 <br /> >_ I certify that the information provided above is true and correct and that only untreated medical wastes are contained in this load. I am aware that <br /> Q falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. <br /> a Anthony Jenkins 08-15-2024 1:49 PM <br /> NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> TRANSFER STATION: NAME REGISTRATION NUMBER <br /> ry NAME(S) OF PERSONS COLLECTING, TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER <br /> Anthony Jenkins AJ TS-167 <br /> O COMPANY NAME TELEPHONE NUMBER <br /> 0- (Stockton) Med-Waste Systems, LLC (818) 998-5533 <br /> Q ADDRESS DATE MEDICAL WASTE COLLECTED <br /> I- 4079 Cherokee Rd Stockton CA 95215 08-15-2024 3:49 PM <br /> z Bio 44 gallon Pharm waste 8 gallon Pharm waste 3 Gal Bio 38 gallon <br /> Q p cont. wt,N #coot. wt,0 p<onl. WL p p cont. wt.# T <br /> Ont. v/t.N <br /> Q 217 4 4 53 1 4 12 727 <br /> N I certify that the information provided above is true and correct and that only untreated medical wastes are contained in this load. I am aware that <br /> Cr w falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. <br /> Anthony Jenkins 1 D 08-15-2024 3:49 PM <br /> or NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> } COMPANY NAME TELEPHONE NUMBER <br /> 1- Healthwise Services (559) 834-3333 <br /> J <br /> V ADDRESS <br /> w 4800 E Lincoln Ave Fowler CA'93625 <br /> Cr PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED <br /> w <br /> LL TSOST-89 08-22-2024 8:36 AM 788.00 <br /> z <br /> Q DISCREPANCY INDICATION SPACE <br /> F- <br /> H <br /> z I certify that I have been authorized to accept untreated medical wastes and that I have received the above indicated wastes in accordance with the <br /> w <br /> g requirements outlined in that authorization. <br /> F- <br /> w Jorge A 08-22-2024 8:36 AM <br /> Cr <br /> NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> In case of emergency, call ( 818 ) 998-5533 (24-hr company or other emergency response group telephone) <br /> Certificate of Destruction: Med-Waste Systems, LLC certifies that the material listed above is treated in accordance with applicable local, state, and federal regulations. <br />