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Regulated Medical Waste <br /> Pag(YRAm$NGDOCUMENT# 7878409 <br /> CODE AREA <br /> UN3291, Regulated Medical Waste, n.o.s., 6.2, PGII 2277 <br /> SYSTEMS , <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 /> 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 US. Department of Transportation. <br /> �l� <br /> Marceline 01-31-202512:01 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 /> Kristi Benoy KB 5039 <br /> COMPANY NAME TELEPHONE NUMBER <br /> ujMed-Waste Systems, LLC (818) 998-5533 <br /> cc ADDRESS DATE MEDICAL WASTE COLLECTED <br /> CL <br /> a 4882 McGrath St Suite 320 Ventura, CA 93003 01-31-2025 12:01 PM <br /> vi <br /> Z Pharm waste 2 gallon Pharm waste 8 gallon Pharm waste > 8 gallon <br /> Q q Cont. wt.q q cont. wt.q q coot. wt.q q coot. wt,q p mot. wt.q <br /> 5 29 4 46 1 32 <br /> 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 <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 /> Kristi Benoy a <br /> I 01-31-2025 12:01 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 /> uj Kristi Benoy KB TS-167 <br /> E COMPANY NAME TELEPHONE NUMBER <br /> (Stockton) Med-Waste Systems, LLC (818) 998-5533 <br /> z ADDRESS DATE MEDICAL WASTE COLLECTED <br /> Q <br /> Imo— 4079 Cherokee Rd Stockton CA 95215 02-04-2025 8:43 AM <br /> Z Pharm waste 2 gallon Pharm waste 8 gallon Pharm waste > 8 gallon <br /> b p Cont. wt.q q cont. VA.q q cent. wt.q q cant. wt.q q cont. wl.q <br /> 1= 5 1 29 4 1 46 1 1 32 <br /> Q <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 /> 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 /> w <br /> Z Kristi 02-04-2025 8:43 AM <br /> Q <br /> cc NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> F— <br /> } COMPANY NAME TELEPHONE NUMBER <br /> F- Healthwise Services (559) 834-3333 <br /> J <br /> V ADDRESS <br /> w 4800 E Lincoln Ave Fowler CA 93625 <br /> PERMIT NUMBER TDATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED <br /> w TSOST-89 2-06-2025 8:29 AM 107.00 <br /> z DISCREPANCY INDICATION SPACE <br /> Q <br /> H <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 /> H <br /> w Jorge 02-06-2025 8:29 AM <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 />