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Regulated Medical Waste <br /> PagtiRACDIiNG DOCUMENT N 7991597 <br /> CODE AREA <br /> UN3291, Regulated Medical Waste, n.o.s., 6.2, PGII 2277 <br /> ". :-`ltlAI'E <br /> SYSTEMS <br /> COMPANY NAME TELEPHONE NUMBER <br /> CHCF-California Heath Care Facility (209) 467-4661 <br /> ADDRESS <br /> cc <br /> 0 7707 S. Austin Rd Stockton, CA 95215 <br /> I-- <br /> cc <br /> I certify that the information provided is true and correct, and that the generated materials are properly classified, described, <br /> Lu <br /> packaged, labeled/placarded; and are in proper condition for transportation according to the applicable regulations of the <br /> z <br /> uj U.S. Department of Transportation. <br /> Marcelino M. " ^'d v1 '>J 02-27-2025 2:09 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 <br /> I— (818) 998-5533 <br /> ADDRESS DATE MEDICAL WASTE COLLECTED <br /> 0. 4882 McGrath St Suite 320 Ventura, CA 93003 02-27-2025 2:09 PM <br /> LA <br /> z Pharm-waste 18 gallon Pharm waste 8 gallon Pharm waste 2 gal�33 <br /> Chemo (trace) waste <br /> ¢ M coot. wt,k q coot, wt M p coot. wt.qq Cont. wt.N q coot. wt.q <br /> 9 182 8 85 8 1 1 <br /> I— <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 m trans porter's registration and/or the privilege of utilizing State-authorized facilities. <br /> ¢ 9 Y Y P 9� P • 9 9 <br /> :�i 7(/, <br /> a Anthony Jenkins y 02-27-2025 2:09 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 /> H Anthony Jenkins AJ TS-167 <br /> O COMPANY NAME TELEPHONE NUMBER <br /> a- (Stockton) Med-Waste Systems, LLC (818) 998 5533 <br /> z ADDRESS <br /> ¢� DATE MEDICAL WASTE COLLECTED <br /> 1— 4079 Cherokee Rd Stockton CA 95215 02-28-2025 1:53 PM <br /> z Pharm waste 18 gallon Pharm waste 8 gallon Pharm waste 2 gallon Chemo (trace) waste <br /> 0 k cant. w p coot,t.A wt.M #cant. wt.B #cant. wt,p N cant, M N <br /> F- 9 182 8 1 85 8 1 33 1 1 <br /> Ln <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 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 /> Ln <br /> Anthony Jenkins ` — 02-28-2025 1:53 PM <br /> NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> } COMPANY NAME TELEPHONE NUMBER <br /> f Healthwise Services (559) 834-3333 <br /> J <br /> U ADDRESS <br /> w 4800 E Lincoln Ave Fowler CA 93625 <br /> PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED <br /> w <br /> LL TSOST-89 03-06-2025 8:36 AM 301.00 <br /> LA <br /> z DISCREPANCY INDICATION SPACE <br /> cc <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 Lee 03-06-2025 8:36 AM <br /> cc <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 />