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Regulated Medical Waste PageRA(WNG DOCUMENT N 7599264 CODE AREA UN3291, Regulated Medical Waste, n.o.s., 6.2, PGII 2277 _ . , ,:- SYSTEMS COMPANY NAME TELEPHONE NUMBER CHCF-California Heath Care Facility (209) 467-4661 ADDRESS p 7707 S. Austin Rd Stockton, CA 95215 I certify that the information provided is true and correct, and that the generated materials are properly classified, described, Z packaged, labeled/placarded; and are in proper condition for transportation according to the applicable regulations of the U.S. Department of Transportation. ,�Llf// Able G. '1 / 11-21-2024 2:53 PM NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE NAME(S) OF PERSONS COLLECTING, TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER Anthony Jenkins AJ 5039 COMPANY NAME TELEPHONE NUMBER w Med-Waste Systems, LLC (818) 998-5533 I-_ cc ADDRESS DATE MEDICAL WASTE COLLECTED O 4882 McGrath St Suite 320 Ventura, CA 93003 11-21-2024 2:53 PM a z Bio 38 gallon Q a cant. wt.q a cant, wt.p p cant. wt.p 9 cant. wt.a 4 coot. wt.p cc 1 1 I— > 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 < falsification of this tracking document may result in forfeiture of m trans porter's registration and/or the privilege of utilizing State-authorized facilities. Q 9 Y Y P 9 P ^, � 9 9 Anthony Jenkins 1 1-21-2024 2:53 PM a NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE TRANSFER STATION: NAME REGISTRATION NUMBER N NAME(S) OF PERSONS COLLECTING, TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER Cr Anthony Jenkins AJ TS-167 COMPANY NAME TELEPHONE NUMBER O 0- (Stockton) Med-Waste Systems, LLC (818) 998-5533 z ADDRESS DATE MEDICAL WASTE COLLECTED Q Imo— 4079 Cherokee Rd Stockton CA 95215 11-21-2024 7:39 PM z Bio 38 gallon O N cant. wt.A p coot. vA.p a cant. wt,p N cant. wt.p a cant. wt,p 1= 1 1 NI 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 cc w falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. z Anthony Jenkins 16— 1 1-21-2024 7:39 PM Q cc NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE F- } COMPANY NAME TELEPHONE NUMBER F Healthwise Services (559) 834-3333 J U ADDRESS w 4800 E Lincoln Ave Fowler CA 93625 PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED w TSOST-89 11-27-2024 9:19 AM 1.00 z Q DISCREPANCY INDICATION SPACE F_ F- 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 w 2E requirements outlined in that authorization. w Pablo Lam— 1 1-27-2024 9:19 AM I--' NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE In case of emergency, call ( 818 ) 998-5533 (24-hr company or other emergency response group telephone) Certificate of Destruction: Med-Waste Systems, LLC certifies that the material listed above is treated in accordance with applicable local, state, and federal regulations.