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Regulated Medical Waste <br /> PageRAaANG DOCUMENT N 7934948 <br /> CODE AREA <br /> UN3291, Regulated Medical Waste, n.o.s., 6.2, PGII 2277 <br /> o`,i; ' 'A.WASTE 1' <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 /> 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 /> l7 U.S. Department of Transportation. <br /> Marcelino M. 02-13-2025 3:13 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 /> � ADDRESS DATE MEDICAL WASTE COLLECTED <br /> O 4882 McGrath St Suite 320 Ventura, CA 93003 02-13-2025 3:13 PM <br /> CL <br /> z Pharm waste 2 gallon Pharm waste 17 gal Reusab (Pharm waste 8 gallon <br /> ¢ p Cont. w, <br /> .p d cont. wt.d d cont. wt.d q cont. wt.d q cont. vA.d <br /> cc 15 58 1 1 19 1 12 1 128 <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 02-13-2025 3:13 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 /> cc w Anthony Jenkins AJ TS-167 <br /> cr COMPANY NAME TELEPHONE NUMBER <br /> O <br /> N (Stockton) Med-Waste Systems, LLC (818) 998-5533 <br /> z ADDRESS DATE MEDICAL WASTE COLLECTED <br /> Fcc <br /> 4079 Cherokee Rd Stockton CA 95215 1 02-13-2025 4:49 PM <br /> z Pharm waste 2 gallon Pharm waste 17 gal Reusab Fharm waste 8 gallon <br /> O d cont, tvt,d d coot, wt.d 0 cont, wt,d q Cont. wt.d d cont. VA.d <br /> �- 15 58 1 1 19 12 1 128 <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 /> 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 /> z Anthony Jenkins 02-13-2025 4:49 PM <br /> H <br /> NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> } COMPANY NAME TELEPHONE NUMBER <br /> i— Healthwise Services (559) 834-3333 <br /> V ADDRESS <br /> 4800 E Lincoln Ave Fowler CA 93625 <br /> PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED <br /> LL TSOST-89 02-20-2025 8:37 AM 205.00 <br /> N <br /> Z DISCREPANCY INDICATION SPACE <br /> F- <br /> H <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 /> � requirements outlined in that authorization. <br /> H f <br /> w Jorge 02-20-2025 8:37 AM <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 />