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Regulated Medical Waste <br /> PageRANNG DOCUMENT N 7341743 <br /> UN3291, Regulated Medical Waste, n.o.s., 6.2, PGII 2277 CODE AREA <br /> SYSTEMS ( !" <br /> COMPANY NAME TELEPHONE NUMBER <br /> CHCF-California Heath Care Facility (209) 467-4661 <br /> ADDRESS <br /> O 7707 S. Austin Rd Stockton, CA 95215 <br /> a I certify that the information provided is true and correct, and that the generated materials are properly classified, described, <br /> Lu <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 /> Gelix V. 09-19-2024 2:09 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 /> ADDRESS DATE MEDICAL WASTE COLLECTED <br /> CL <br /> Ln 4882 McGrath St Suite 320 Ventura, CA 93003 09-19-2024 2:09 PM <br /> to <br /> z Pharm waste 8 gallon Pharm waste 2 gallon Pharm waste 18 gallon <br /> Q 4 cent, wt.a a cant. wt.a a cont. wt.9 a rant. wL a a cunt. wt,a <br /> 2 22 2 8 1 14 <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 /> a 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 09-19-2024 2:09 PM <br /> NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> TRANSFER STATION: NAME REGISTRATION NUMBER <br /> r4 NAME(S) OF PERSONS COLLECTING, TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER <br /> Lu Anthony Jenkins AJ TS-167 <br /> COMPANY NAME TELEPHONE NUMBER <br /> O <br /> N (Stockton) Med-Waste Systems, LLC (818) 998-5533 <br /> z <br /> a ADDRESS DATE MEDICAL WASTE COLLECTED <br /> 4079 Cherokee Rd Stockton CA 95215 09-23-2024 8:16 PM <br /> z Pharm waste 8 gallon Pharm waste 2 gallon Pharm waste 18 gallon <br /> a coot, wt.X a cool. VA.N N coot. wt.a T <br /> cant, wt.a q cant. VA. <br /> a <br /> F 2 22 2 8 1 14 <br /> UP 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 falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. <br /> w <br /> QAnthony Jenkins > 09-23-2024 8:16 PM <br /> cc NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> I. <br /> } COMPANY NAME TELEPHONE NUMBER <br /> I- Healthwise Services (559) 834-3333 <br /> J <br /> V ADDRESS <br /> w 4800 E Lincoln Ave Fowler CA 93625 <br /> Cr PERMIT NUMBER TDATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED <br /> LL TSOST-89 9-26-2024 8:31 AM 44.00 <br /> z Q DISCREPANCY INDICATION SPACE <br /> F- <br /> 1— <br /> t— <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 /> w Jorge A 09-26-2024 8:31 AM <br /> cc <br /> F- 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 />