Laserfiche WebLink
Regulated Medical Waste <br /> PageRIewI NGDOCUMENT# 7734001 <br /> CODE AREA <br /> iI <br /> UN3291, Regulated Medical Waste, n.o.s., 6.2, PG11 2277 <br /> sj ,UilAS� E <br /> SYSTEMS t <br /> COMPANY NAME TELEPHONE NUMBER <br /> CHCF-California Heath Care Facility (209) 467-4661 <br /> ADDRESS <br /> p 7707 S. Austin Rd Stockton, CA 95215 <br /> F- <br /> cc 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 /> uj U.S. Department of Transportation, <br /> Able G, 12-26-2024 1:46 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 /> F- <br /> or ADDRESS DATE MEDICAL WASTE COLLECTED <br /> 0 4882 McGrath St Suite 320 Ventura, CA 93003 12-26-2024 1:46 PM <br /> a <br /> to <br /> z Pharm waste 3 Gal Pharm waste 8 gallon Pharm waste 3 Gal <br /> Q R cool. wt.p W cant. VA.p M Cont. wt.N q coot. wt.M 71q cool. wt.Y <br /> � 6 26 8 97 1 3 <br /> F <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 /> Qfalsification 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 12-26-2024 1:46 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 /> E COMPANY NAME TELEPHONE NUMBER <br /> a (Stockton) Med-Waste Systems, LLC (818) 998-5533 <br /> Q ADDRESS DATE MEDICAL WASTE COLLECTED <br /> II— 4079 Cherokee Rd Stockton CA 95215 12-27-2024 2:14 PM <br /> z Pharm waste 3 Gal Pharm waste 8 gallon Pharm waste 3 Gal <br /> Q B Cont. wt.P #Cont. wt.A M Cont. wt.p #Cont. wt,q p coot. wt.Y <br /> H 6 26 8 97 1 3 <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 /> cc falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. <br /> Lu <br /> LL <br /> QAnthony Jenkins 12-27-2024 2:14 PM <br /> F <br /> NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> r COMPANY NAME TELEPHONE NUMBER <br /> F Healthwise Services (559) 834-3333 <br /> J <br /> V ADDRESS <br /> < 4800 E Lincoln Ave Fowler CA 93625 <br /> LL <br /> PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED <br /> Lu <br /> LL TSOST-89 12-27-2024 2:15 PM 126,00 <br /> to <br /> z 4 DISCREPANCY INDICATION SPACE <br /> cc <br /> F- <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 /> :E requirements outlined in that authorization. <br /> F <br /> w Jorge Ambriz �_ 12-27-2024 2:15 PM <br /> cc <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 />