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Regulated Medical Waste <br /> PagffRAGANGDOCUMENT# 8361599 <br /> w <br /> UN3291 , Regulated Medical Waste, n.o.s., 6.2, PGII 2277 CODE AREA <br /> ,..'1� lr,,V AS B t_ ' <br /> '�. SYSTEMS <br /> COMPANY NAME TELEPHONE NUMBER <br /> CHCF-California Heath Care Facility (209) 467-4661 <br /> ADDRESS <br /> O 7707 S. Austin Rd Stockton, CA 95215 <br /> F— <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 /> Marcelino M �� 05-29-2025 1:24 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 /> cc ADDRESS DATE MEDICAL WASTE COLLECTED <br /> O 4882 McGrath St Suite 320 Ventura, CA 93003 05-29-2025 1:24 PM <br /> a <br /> In <br /> z Pharm waste 8 gallon <br /> ¢ pCont, wt.X XCont, wt.a Jgcoot. wt.X Xmot. M.X XCont. vt.q <br /> 1 14 <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 my transporter's registration and/or the privilege of utilizing State-authorized facilities. <br /> a <br /> Anthony Jenkins —47 05-29-2025 1:24 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 /> W Anthony Jenkins AJ TS-167 <br /> E COMPANY NAME TELEPHONE NUMBER <br /> O <br /> CL (Stockton) Med-Waste Systems, LLC (818) 998-5533 <br /> z ADDRESS DATE MEDICAL WASTE COLLECTED <br /> ¢ <br /> F_ 4079 Cherokee Rd Stockton CA 95215 05-29-2025 2:36 PM <br /> z Pharm waste 8 gallon <br /> O X Cont. wt.X p cant. wl.X p coot. wt.X T cont. wt.X p coot. <br /> F 1 14 <br /> NI 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 <br /> 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 /> z Anthony Jenkins 05-29-2025 2:36 PM <br /> NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> COMPANY NAME TELEPHONE NUMBER <br /> I— Healthwise Services (559) 834-3333 <br /> J <br /> U ADDRESS <br /> < 4800 E Lincoln Ave Fowler CA 93625 <br /> LL <br /> cc PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED <br /> LL TSOST-89 06-05-2025 8:06 AM 14.00 <br /> to <br /> z DISCREPANCY INDICATION SPACE <br /> H <br /> H <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 /> Lu 6\ <br /> w Jorge A 06-05-2025 8:06 AM <br /> t' 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 />