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Regulated Medical Waste <br /> PagffRA(WOG DOCUMENT 8448329 <br /> UN3291, Regulated Medical Waste, n.o.s•, 6.2, PGII 2277 CODE AREA <br /> r_ =•x�lUASTE ,, <br /> , 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 /> 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 /> "' U.S. Department of Transportation. <br /> LD <br /> Marcelino M 06-19-2025 12:32 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 /> 0Y ADDRESS DATE MEDICAL WASTE COLLECTED <br /> CL d 4882 McGrath St Suite 320 Ventura, CA 93003 06-19-2025 12:32 PM <br /> to <br /> z Pharm was 8 gallon Pharm waste 2 gallon <br /> Q p cont. \vt.p p cont. It.p p cont. wt,p q coot. wt.p 4 conL vrt.9 <br /> H <br /> 1 230 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 /> 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 Anthony Jenkins 06 19 2025 12:32 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 /> cc uj <br /> Anthony Jenkins AJ TS 167 <br /> O COMPANY NAME TELEPHONE NUMBER <br /> N (Stockton) Med-Waste Systems, LLC (818) 998-5533 <br /> z <br /> Q ADDRESS DATE MEDICAL WASTE COLLECTED <br /> cc <br /> I— 4079 Cherokee Rd Stockton CA 95215 1 06-19-2025 2:33 PM <br /> z Pharm waste 8 gallon Pharm waste 2 gallon <br /> 0 p cunt. Wt.p p cont. wt,p p cont. wt.p p cant wl.p p coot. VA.N <br /> � 1 230 1 3 <br /> Q <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 /> or 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 /> QLL / _ <br /> Anthony Jenkins lef4 "- 06-19-2025 2:33 PM <br /> cc NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> } COMPANY NAME TELEPHONE NUMBER <br /> i Healthwise Services (559) 834-3333 <br /> V ADDRESS <br /> LL 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 06-26-2025 7:54 AM 233.00 <br /> to <br /> z Q DISCREPANCY INDICATION SPACE <br /> a <br /> H <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 /> g requirements outlined in that authorization. <br /> F— <br /> w Jorge A 06-26-2025 7:54 AM <br /> cc <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 />