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Regulated Medical Waste <br /> PageRAWNGDOCUMENT# 8078717 <br /> ' UN3291 , Regulated Medical Waste, n.o.s., 6.2, PGII 2277 CODE AREA <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 /> H <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 /> Lu U.S. Department of Transportation. <br /> Marcelino M. 03-20-2025 1:31 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 /> I_ <br /> cj� ADDRESS DATE MEDICAL WASTE COLLECTED <br /> 0- 4882 McGrath St Suite 320 Ventura, CA 93003 03-20-2025 1:31 PM <br /> In <br /> Z Pharm waste 8 gallon Pharm waste 2 gallon <br /> Q a Cont. wt.# a cant. wt.# q mot. wt.p a Cont. wt.p p coot. v t.# <br /> F <br /> 2 30 3 13 <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 /> a Anthony Jenkins 03-20-2025 1:31 PM <br /> NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> TRANSFER STATION: NAME FREGISTRATION 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 /> (Stockton) Med-Waste Systems, LLC (818) 998-5533 <br /> Q ADDRESS DATE MEDICAL WASTE COLLECTED <br /> 4079 Cherokee Rd Stockton CA 95215 03-25-2025 4:05 PM <br /> Z Pharm waste 8 gallon Pharm waste 2 gallon <br /> 0 p cant. wt,p a mot. Wt.# #cons. wt.a a mot wt.a a coot, wt.# <br /> F— 2 30 3 13 <br /> a <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 /> Anthony Jenkins � 03-25-2025 4:05 PM <br /> cr NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> H <br /> } COMPANY NAME TELEPHONE NUMBER <br /> I Healthwise Services (559) 834-3333 <br /> J <br /> V ADDRESS <br /> < 4800 E Lincoln Ave Fowler CA 93625 <br /> or, PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED <br /> w <br /> LL TSOST-89 03-27-2025 11:31 AM 43.00 <br /> Z Q DISCREPANCY INDICATION SPACE <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 /> requirements outlined in that authorization. <br /> f— <br /> Lu Jorge / �—� ' 03-27-2025 11:31 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 />