Laserfiche WebLink
Regulated Medical Waste <br /> PagGRAw110G DOCUMENT k 7312607 <br /> CODE AREA <br /> UN3291, Regulated Medical Waste, n.o.s., 6.2, PGII 2277 <br /> �p)!V E� P <br /> *c-VVT S Y'y�E <br /> }, SYSTEMS <br /> COMPANY NAME TELEPHONE NUMBER <br /> CHCF-California Heath Care Facility (209) 467-4661 <br /> ADDRESS <br /> cc <br /> p 7707 S. Austin Rd Stockton, CA 95215 <br /> I— <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 /> Lu U.S. Department of Transportation. <br /> xtl <br /> Able G. 09-12-2024 1:18 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 /> I— <br /> cL ADDRESS DATE MEDICAL WASTE COLLECTED <br /> CL a 4882 McGrath St Suite 320 Ventura, CA 93003 09-12-2024 1:18 PM <br /> to <br /> z Pharm waste 2 gallon Bio 38 gallon <br /> p cont. wt.p q coot. vrt.p p con(. wt.p p cont. wt,p p cont, wl,p <br /> 2 1 13 1 10 <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 /> cc <br /> ¢ falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. <br /> cc Anthony Jenkins 09-12-2024 1:18 PM <br /> NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> TRANSFER STATION: NAME TREGISTRATION NUMBER <br /> ry NAME(S) OF PERSONS COLLECTING, TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER <br /> or Anthony Jenkins AJ TS-167 <br /> O COMPANY NAME TELEPHONE NUMBER <br /> C (Stockton) Med-Waste Systems, LLC (818) 998-5533 <br /> z ADDRESS DATE MEDICAL WASTE COLLECTED <br /> I— 4079 Cherokee Rd Stockton CA 95215 09-12-2024 4:28 PM <br /> z Pharm waste 2 gallon Bio 38 gallon <br /> 0 p cont, wL p p mnl. wt.p p cont. Wt.p p conl, wt.p p coot. wt.p <br /> H 2 13 1 10 <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 /> Ln <br /> 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 09-12-2024 4:28 PM <br /> F_F- <br /> NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> } COMPANY NAME TELEPHONE NUMBER <br /> Healthwise Services (559) 834-3333 <br /> J <br /> V ADDRESS <br /> LL 4800 E Lincoln Ave Fowler CA 93625 <br /> w <br /> PERMIT NUMBER :JDATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED <br /> w TSOST-89 9-19-2024 8:24 AM 23.00 <br /> In <br /> z DISCREPANCY INDICATION SPACE <br /> H <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 /> �E requirements outlined in that authorization. <br /> H <br /> w Pablo Aguilar / 09-19-2024 8:24 AM <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 />