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Regulated Medical Waste <br /> Pag(FRAWNG DOCUMENT N 8391656 <br /> m UN3291, Regulated Medical Waste, n.o.s., 6.2, PGII 2277 CODE AREA <br /> D;�iltlASTE ` '. <br /> a SYSTEMS <br /> COMPANY NAME TELEPHONE NUMBER <br /> CHCF-California Heath Care Facility (209) 467-4661 <br /> ADDRESS <br /> cc <br /> 0 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 /> LU U.S. Department of Transportation. <br /> Marcelino M 0- ' 06-05-2025 2:24 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 /> cc w Med-Waste Systems, LLC (818) 998-5533 <br /> ADDRESS DATE MEDICAL WASTE COLLECTED <br /> 0 4882 McGrath St Suite 320 Ventura, CA 93003 06-05-2025 2:24 PM a <br /> z Pharm waste 8 gallon Pharm waste 2 gallon <br /> Q q rant. w1.p a cool. v t.q p Cont. wt.p p coot, wt,p p Cont. wt.p <br /> cc 12 141 1 3 <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 /> �Ecc /� <br /> Anthony Jenkins _4 06-05-2025 2:24 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 /> Anthony Jenkins AJ TS-167 <br /> O COMPANY NAME TELEPHONE NUMBER <br /> Q_ (Stockton) Med-Waste Systems, LLC (818) 998-5533 <br /> z <br /> cc ADDRESS DATE MEDICAL WASTE COLLECTED <br /> cc <br /> F- 4079 Cherokee Rd Stockton CA 95215 1 06-05-2025 1:06 PM <br /> z Pharm waste 8 gallon Pharm waste 2 gallon <br /> 0 p Cont. wi.p p Cont. VA.p p Cont. wt.p p Cont. 1 VA.p p Cont. vA.p <br /> P 12 141 1 3 <br /> a <br /> N 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 /> LL <br /> QAnthony Jenkins 06-05-2025 1:06 PM <br /> cc <br /> NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> } COMPANY NAME TELEPHONE NUMBER <br /> t— Healthwise Services (559) 834-3333 <br /> J <br /> V ADDRESS <br /> < 4800 E Lincoln Ave Fowler CA 93625 <br /> w <br /> PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED <br /> LL TSOST-89 06-12-2025 7:58 AM 144.00 <br /> to <br /> z Q 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 /> requirements outlined in that authorization. <br /> I-- <br /> w Jorge a 06-12-2025 7:58 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 />