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Regulated Medical Waste <br /> Pag(FRAaANG DOCUMENT# 7653251 <br /> a , . CODE AREA <br /> 4,ry UN3291 , Regulated Medical Waste, n.o.s., 6.2, PGII 2277 <br /> �, UI,W S TE <br /> S �SYSTEM <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 /> F- <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 /> Lu U.S, Department of Transportation. <br /> Marcelino M. 12-05-2024 3:18 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 <br /> Med-Waste Systems, LLC (818) 998-5533 <br /> 0c ADDRESS DATE MEDICAL WASTE COLLECTED <br /> 0 4882 McGrath St Suite 320 Ventura, CA 93003 12-05-2024 3:18 PM <br /> a <br /> z Pharm waste 8 gallon Chemo (trace) waste Pharm waste 18 gallon Sharps 3 gallon <br /> Q k cool. wt.M N mot. wt.q A cunt, wt.q q coot. wl.k 74 ,nt, vR.A <br /> 5 30 3 4 2 41 2 5 <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 <br /> Anthony Jenkins 12-05-2024 3:18 PM <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 Anthony Jenkins AJ TS-167 <br /> COMPANY NAME TELEPHONE NUMBER <br /> a (Stockton) Med-Waste Systems, LLC (818) 998-5533 <br /> Q ADDRESS DATE MEDICAL WASTE COLLECTED <br /> 4079 Cherokee Rd Stockton CA 95215 12-05-2024 5:43 PM <br /> z Pharm was 8 gallon Dhemo (trace) waste Pharm waste 18 gallon Sharps 3 gallon <br /> Q #Cont. w(,p 5 3 2 41 1 cunt, wt.0 k Cont. wt,p N cont. 2 5 nt. wt.A p cunt. wt,k <br /> 1= 30 4 <br /> 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 <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 /> aAnthony Jenkins 12-05-2024 5:43 PM <br /> H <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 /> w 4800 E Lincoln Ave Fowler CA 93625 <br /> PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED <br /> LL TSOST-89 12-12-2024 9:19 AM 80 <br /> z Q DISCREPANCY INDICATION SPACE <br /> N <br /> f— <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 /> 2 requirements outlined in that authorization. <br /> H /�^ <br /> w Jorge 1 2-1 2-2024 9:19 AM <br /> I 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 />