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Regulated Medical Waste PagG'RAQD;MG DOCUMENT# 7758211 CODE AREA UN3291, Regulated Medical Waste, n.o.s., 6.2, PGII 2277 SVSTEMs COMPANY NAME TELEPHONE NUMBER CHCF-California Heath Care Facility (209) 467-4661 ADDRESS O 7707 S. Austin Rd Stockton, CA 95215 F- 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 LU U.S. Department of Transportation. pp Marcelino M. vL 01-02-2025 2:31 PM NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE NAME(5) 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 F- � ADDRESS DATE MEDICAL WASTE COLLECTED 0 4882 McGrath St Suite 320 Ventura, CA 93003 01-02-2025 2:31 PM a to z Pharm waste 2 gallon Pharm waste 8 gallon Sharps 5 qt Q N cant. wt.p p cool. vR.q N Cont. wt.N p coot wt.N 71q coot. wt.N F- 7 28 7 85 1 3 F- r 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 Q falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. a Anthony Jenkins 0 1-02-2025 2:31 PM 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 Lu Anthony Jenkins AJ TS-167 R COMPANY NAME TELEPHONE NUMBER O N (Stockton) Med-Waste Systems, LLC (818) 998-5533 Z ADDRESS DATE MEDICAL WASTE COLLECTED cc Fcc 4079 Cherokee Rd Stockton CA 95215 01-08-2025 11:23 AM z Pharm waste 2 gallon Pharm waste 8 gallon Sharps 5 qt O p cant. wt.p p coot wt.N N cant. wt N N coot. wt.N N cant, v 1.N 7 28 7 85 1 3 N 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 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 "� 01-08-2025 11:23 AM Q cr NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE F r COMPANY NAME TELEPHONE NUMBER F Healthwise Services (559) 834-3333 V ADDRESS LL 4800 E Lincoln Ave Fowler CA 93625 cc PERMIT NUMBER DATE WASTE WA5 DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED tW TSOST-89 01-09-2025 11:25 AM 116.00 z DISCREPANCY INDICATION SPACE Q cc H 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 requirements outlined in that authorization. w Jorge Ambriz 01-09-2025 11:25 AM 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.