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Regulated Medical Waste <br /> PagB'RAaANGDOCUMENT# 8050606 <br /> CODE AREA <br /> f' UN3291, Regulated Medical Waste, n.o.s., 6.2, PGII 2277 <br /> - <br /> WASTE � ( <br /> SYSTEMS <br /> jj <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 /> cc 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 /> Able G. ' 03-13-2025 1:34 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 /> H <br /> W ADDRESS DATE MEDICAL WASTE COLLECTED <br /> O 4882 McGrath St Suite 320 Ventura, CA 93003 03-13-2025 1:34 PM <br /> a <br /> to <br /> z Pharm waste 2 gallon Pharm waste 8 gallon <br /> Q b cant. wt.b p cant. vIt.q q coot. wt.k q coot. wt.q q<oni. vrt.q <br /> F- 37 129 6 59 <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 /> °C Anthony Jenkins 03-13-2025 1:34 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 /> LU <br /> Anthony Jenkins AJ TS 167 <br /> t COMPANY NAME TELEPHONE NUMBER <br /> O <br /> CL (Stockton) Med-Waste Systems, LLC (818) 998-5533 <br /> Z <br /> Q ADDRESS DATE MEDICAL WASTE COLLECTED <br /> I— 4079 Cherokee Rd Stockton CA 95215 03-18-2025 3:08 PM <br /> z Pharm waste 2 gallon Pharm waste 8 gallon <br /> O N cant. wt.p b cool. A.b b coot. wt.p q cant. wt.k F# -nt <br /> wt. <br /> p <br /> h 37 129 6 59 <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 /> QAnthony Jenkins 03-18-2025 3:08 PM <br /> � NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> I.— <br /> r COMPANY NAME TELEPHONE NUMBER <br /> E- Healthwise Services (559) 834-3333 <br /> J <br /> l J ADDRESS <br /> `c 4800 E Lincoln Ave Fowler CA 93625 <br /> w <br /> PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED <br /> LL TSOST-89 03-20-2025 11:30 AM 188.00 <br /> z¢ DISCREPANCY INDICATION SPACE <br /> t— <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 /> 2Ej requirements outlined in that authorization. <br /> w Jorge 03-20-2025 11 :30 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 />