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Regulated Medical Waste <br /> PagffRA,WU NG DOCUMENT# 8277492 <br /> r. k", UN3291, Regulated Medical Waste, n.o.s., 6.2, PGII 2277 CODE AREA <br /> x 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 /> F— <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 /> ui U.S. Department of Transportation. C <br /> Able G \ 05-08-2025 1:59 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 /> cr w Med-Waste Systems, LLC (818) 998-5533 <br /> I— <br /> CC ADDRESS DATE MEDICAL WASTE COLLECTED <br /> O 4882 McGrath St Suite 320 Ventura, CA 93003 05-08-2025 1:59 PM <br /> CL <br /> to <br /> z Pharm waste 2 gallon Pharm waste 8 gallon Pharm waste 18 gallon Ta�emo (trace) waste <br /> q coot. wl.M q coot t,p d cool. t.X wl,k q cool.6 34 18 244 4 792 3 <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 /> 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_a Anthony Jenkins 05-08-2025 1:59 PM <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 /> tom,., Anthony Jenkins AJ TS-167 <br /> E COMPANY NAME TELEPHONE NUMBER <br /> O <br /> 0- (Stockton) Med-Waste Systems, LLC (818) 998-5533 <br /> z ADDRESS DATE MEDICAL WASTE COLLECTED <br /> ~ 4079 Cherokee Rd Stockton CA 95215 05-08-2025 3:46 PM <br /> z Pharm waste 2 gallon Pharm waste 8 gallon Pharm waste 18 gallon Chemo (trace) waste <br /> O p cant. wt W p cant. wt.p d cont. wt.M p cant. wt.4 p cool. wt.M <br /> F= 6 34 18 244 4 79 2 3 <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 /> Cr falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. <br /> w <br /> LL <br /> Anthony Jenkins 05-08-2025 3:46 PM <br /> or NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> F- <br /> r COMPANY NAME TELEPHONE NUMBER <br /> I— Healthwise Services (559) 834-3333 <br /> J <br /> V ADDRESS <br /> LL 4800 E Lincoln Ave Fowler CA 93625 <br /> cc PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED <br /> U_' TSOST-89 05-15-2025 8:15 AM 360. )0 <br /> to <br /> z DISCREPANCY INDICATION SPACE <br /> Q <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 /> 2 requirements outlined in that authorization. <br /> w Jorge A 05-15-2025 8:15 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 />