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Regulated Medical Waste <br /> PagffRACQQINGDOCUMENT# 8247662 <br /> CODE AREA <br /> rj <br /> UN3291 , Regulated Medical Waste, n.o.s., 6.2, PGII 2277 <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— <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. fg <br /> Able G J 05-01-2025 11:04 AM <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 /> x ADDRESS DATE MEDICAL WASTE COLLECTED <br /> 0 4882 McGrath St Suite 320 Ventura, CA 93003 05-01-2025 11:04 AM <br /> a <br /> z Pharm waste 8 gallon Pharm waste 2 gallon <br /> ¢ p coot. wt.N N cont. vrt.p q mot. wt.N N cant. wt.N q cool. vR.p <br /> 33 416 9 35 <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 /> Anthony Jenkins 05-01-2025 11:04 AM <br /> NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> TRANSFER STATION: NAME REGISTRATION NUMBER <br /> ry NAME(S) OF PERSONS COLLECTING, TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER <br /> uj <br /> cc Anthony Jenkins AJ TS-167 <br /> Cr COMPANY NAME TELEPHONE NUMBER <br /> a- (Stockton) Med-Waste Systems, LLC (818) 998-5533 <br /> Z <br /> ¢ ADDRESS DATE MEDICAL WASTE COLLECTED <br /> Cr <br /> 4079 Cherokee Rd Stockton CA 95215 05-01-2025 2:20 PM <br /> z Pharm waste 8 gallon Pharm waste 2 gallon <br /> Q N Cont. wL N N cont. wl.N p cont. wt.q p coot. wl.p N coot. v k.a <br /> P: 33 416 9 35 <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— 05-01-2025 2:20 PM <br /> NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> r COMPANY NAME TELEPHONE NUMBER <br /> I Healthwise Services (559) 834-3333 <br /> V ADDRESS <br /> < 4800 E Lincoln Ave Fowler CA 93625 <br /> cc PERMIT NUMBER TDATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED <br /> LL TSOST-89 5-OS-2025 8:23 AM 451.00 <br /> In <br /> Z DISCREPANCY INDICATION SPACE <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 /> :�j requirements outlined in that authorization. <br /> F- <br /> w Jorge a 05-08-2025 8:23 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 />