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Regulated Medical Waste <br /> Pag@RA(Df NG DOCUMENT B 8420140 <br /> - UN3291, Regulated Medical Waste, n.o.s., 6.2, PGII 2277 CODE AREA <br /> SYSTEMS <br /> COMPANY NAME TELEPHONE NUMBER <br /> CHCF-California Heath Care Facility (209) 467-4661 <br /> ADDRESS <br /> cc <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 /> LU U.S. Department of Transportation. <br /> Marcelino M / x 06-12-2025 12:58 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 /> F- <br /> cr ADDRESS DATE MEDICAL WASTE COLLECTED <br /> 4882 McGrath St Suite 320 Ventura, CA 93003 06-12-2025 12:58 PM <br /> z Pharm waste 8 gallon <br /> ¢ b cant. wt.q N cant, MIN q cant, wt.p M cant. wt.k N cont. I wt.R <br /> H- <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 m trans porter's registration and/or the privilege of utilizing State-authorized facilities. <br /> ¢ 9 Y Y P 9� P � 9 9 <br /> a Anthony Jenkins 06-12-2025 12:58 PM <br /> NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> TRANSFER STATION: NAME REGISTRATION NUMBER <br /> N NAME(5) OF PERSONS COLLECTING, TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER <br /> cc <br /> Lu <br /> Anthony Jenkins AJ TS-167 <br /> O COMPANY NAME TELEPHONE NUMBER <br /> a_ (Stockton) Med-Waste Systems, LLC (818) 998-5533 <br /> Z ADDRESS <br /> ¢� DATE MEDICAL WASTE COLLECTED <br /> t— 4079 Cherokee Rd Stockton CA 95215 06-13-2025 2:54 PM <br /> z Pharm waste 8 gallon <br /> 0 #cant. 1 12 wt.p M coot. vR.q q coot. wt,q R coot. wt.N 4 cant. wt.R <br /> H <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 /> 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. <br /> LL <br /> Anthony Jenkins 06-13-2025 2:54 PM <br /> NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> COMPANY NAME TELEPHONE NUMBER <br /> F Healthwise Services (559) 834-3333 <br /> U ADDRESS <br /> < 4800 E Lincoln Ave Fowler CA 93625 <br /> w <br /> PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED <br /> W- TSOST-89 06-19-2025 7:53 AM 12.00 <br /> to <br /> z DISCREPANCY INDICATION SPACE <br /> t-- <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 /> g requirements outlined in that authorization. <br /> F- <br /> LU Jorge A 06-19-2025 7:53 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 />