Laserfiche WebLink
Regulated Medical Waste <br /> PagBfRANNGDOCUMENT# 7543359 <br /> - CODE AREA <br /> j UN3291, Regulated Medical Waste, n.o.s., 6.2, PGII 2277 <br /> SYSTEMS t„ ' <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 /> I 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 /> w U.S. Department of Transportation. <br /> � Matvelono I// per^ 11-08-2024 11:55 AM <br /> NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> NAME(S) OF PERSONS COLLECTING, TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER <br /> Kristi Benoy KB 5039 <br /> COMPANY NAME TELEPHONE NUMBER <br /> w Med-Waste Systems, LLC (818) 998-5533 <br /> I— <br /> cr ADDRESS DATE MEDICAL WASTE COLLECTED <br /> 0 4882 McGrath St Suite 320 Ventura, CA 93003 11-08-2024 11:55 AM <br /> a <br /> to <br /> z Pharm waste 8 gallon <br /> ¢ #Cont. wt.# #cont. wt.# #cont. wt,# #coot. wt.# F# -t <br /> vrt.p <br /> � 4 68 <br /> r- <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 /> 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 /> cc Kristi Benoy y — 11-08-2024 11:55 AM <br /> NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> TRANSFER STATION: NAME REGISTRATION NUMBER <br /> N NAME(S) OF PERSONS COLLECTING, TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER <br /> w Kristi Benoy KB TS-167 <br /> COMPANY NAME TELEPHONE NUMBER <br /> O <br /> Q_ (Stockton) Med-Waste Systems, LLC (818) 998-5533 <br /> z ADDRESS DATE MEDICAL WASTE COLLECTED <br /> ~ 4079 Cherokee Rd Stockton CA 95215 11-09-2024 7:33 PM <br /> z Pharm waste 8 gallon <br /> Q #cont. wt.# N<Oot. vR.# #conl. WI.N Xcont. Wt.# #CON. VA.# <br /> t= 4 68 <br /> H <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 /> 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 /> LL <br /> z Kristi 1 1-09-2024 7:33PM <br /> NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> } COMPANY NAME TELEPHONE NUMBER <br /> F— Healthwise Services (559) 834-3333 <br /> J <br /> U ADDRESS <br /> LL 4800 E Lincoln Ave Fowler CA 93625 <br /> PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED <br /> LL TSOST-89 11-21-2024 8:14 AM 68.00 <br /> to <br /> z 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 /> :E requirements outlined in that authorization, <br /> Lu <br /> w Jorge 1 1-21-2024 8:14AM <br /> or <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 />