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Regulated Medical Waste PagaRA,o NG DOCUMENT u 8391629 j CODE AREAUN3291, Regulated Medical Waste, n.o.s., 6.2, PGII 2277 STE SYSTEMS i= COMPANY NAME TELEPHONE NUMBER CHCF-California Heath Care Facility (209) 467-4661 ADDRESS p 7707 S. Austin Rd Stockton, CA 95215 H cl:: I certify that the information provided is true and correct, and that the generated materials are properly classified, described, z packaged, labeled/placarded; and are in proper condition for transportation according to the applicable regulations of the uj U.S. Department of Transportation. Chris Mulin 06-05-2025 2:13 PM NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE NAME(S) OF PERSONS COLLECTING, TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER Anthony Jenkins AJ 5039 COMPANY NAME TELEPHONE NUMBER w Med-Waste Systems, LLC (818) 998 5533 H cr, ADDRESS DATE MEDICAL WASTE COLLECTED 0 4882 McGrath St Suite 320 Ventura, CA 93003 06 05-2025 2:13 PM z Q p cant. wt.p Fgcont. vrt.p p Cont. wt.p p cant, wt.p p cant, v t.p cc I-- >_ 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 Q falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. Cr Anthony Jenkins 06-05-2025 2:13 PM a NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE TRANSFER STATION: NAME REGISTRATION NUMBER ry NAME(S) OF PERSONS COLLECTING, TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER LU Anthony Jenkins AJ TS-167 O COMPANY NAME TELEPHONE NUMBER � (Stockton) Med-Waste Systems, LLC (818) 998-5533 z ADDRESS DATE MEDICAL WASTE COLLECTED cc t— 4079 Cherokee Rd Stockton CA 95215 06-05 2025 1:06 PM 0 p cant. wt.p p cant. wt, p p cant. wt.0 p cant, wt.p p coot. wt.p Q F_ 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 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. LL Anthony Jenkins 06-05-2025 1:06 PM 0: NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE } COMPANY NAME TELEPHONE NUMBER I— Healthwise Services (559) 834-3333 J V ADDRESS w 4800 E Lincoln Ave Fowler CA 93625 PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED w w TSOST-89 06-12-2025 7:58 AM to z Q DISCREPANCY INDICATION SPACE F- F- 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 w requirements outlined in that authorization. w Jorge a 06-12-2025 7:58 AM cc H NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE In case of emergency, call ( 818 ) 998-5533 (24-hr company or other emergency response group telephone) Certificate of Destruction: Med-Waste Systems, LLC certifies that the material listed above is treated in accordance with applicable local, state, and federal regulations.