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Regulated Medical Waste <br /> PagffRANNG DOCUMENT B 7961651 <br /> CODE AREA <br /> UN3291, Regulated Medical Waste, n.o.s., 6.2, PGII 2277 <br /> -'';WASTE <br /> SYSTEMS <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 /> Cr 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 /> Marcelino M. 02-20-2025 2:08 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 /> cc ADDRESS DATE MEDICAL WASTE COLLECTED <br /> 0 4882 McGrath St Suite 320 Ventura, CA 93003 02-20-2025 2:08 PM <br /> a <br /> to <br /> z Pharm waste 2 gallon Pharm waste 8 gallon <br /> Q q cont wt.q q cunt. v/t.q q cunt. wt.q q cunt. wt,q q cunt. Wt.q <br /> 8 1 37 1 1 1 11 <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 /> cc <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 /> cc Anthony Jenkins 7`b 02-20-2025 2:08 PM <br /> a <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 Anthony Jenkins AJ TS-167 <br /> O COMPANY NAME TELEPHONE NUMBER <br /> N (Stockton) Med-Waste Systems, LLC (818) 998-5533 <br /> z <br /> Q ADDRESS DATE MEDICAL WASTE COLLECTED <br /> F 4079 Cherokee Rd Stockton CA 95215 02-20-2025 1 :48 PM <br /> z Pharm waste 2 gallon Pharm waste 8 gallon <br /> 0 q cunt. wt.q q cunt. wt.q q cont. wt,q q cont, wt.q q cunt. M.q <br /> t- 8 1 37 1 1 11 <br /> 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 <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 /> LL <br /> QAnthony Jenkins 02-20-2025 1:48 PM <br /> cc <br /> NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> } COMPANY NAME TELEPHONE NUMBER <br /> I_ Healthwise Services (559) 834-3333 <br /> J <br /> U ADDRESS <br /> LL 4800 E Lincoln Ave Fowler CA 93625 <br /> w <br /> PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED <br /> u- TSOST-89 02-27-2025 1:52 PM 48.00 <br /> to <br /> z <br /> Q DISCREPANCY INDICATION SPACE <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 /> 2i requirements outlined in that authorization. <br /> F _ <br /> w Jorge Ambriz 02-27-2025 1:52 PM <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 />