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Regulated Medical Waste <br /> PagertAaANG DOCUMENT n 8478312 <br /> G', <br /> - CODE AREA <br /> UN3291, Regulated Medical Waste, n.o.s., 6.2, PGII 2277 <br /> ;UtP�STE <br /> ' j.. 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 /> F- <br /> I certify that the information provided is true and correct, and that the generated materials are properly classified, described, <br /> LU <br /> Z packaged, labeled/placarded; and are in proper condition for transportation according to the applicable regulations of the <br /> z <br /> Lu U.S. Department of Transportation. <br /> Marcelino M 06-26-2025 1:32 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 /> ADDRESS DATE MEDICAL WASTE COLLECTED <br /> C)n- <br /> 4882 McGrath St Suite 320 Ventura, CA 93003 06-26-2025 1:32 PM <br /> tn <br /> z Pharm waste 8 gallon Pharm waste 18 gallon <br /> Q N cont. wt.N N font. VA.q Fg—t <br /> q Cont. wt,p p coot wt.N <br /> H <br /> 5 70 2 29 <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 /> cc <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 /> Cr Anthony Jenkins 06-26-2025 1:32 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 /> Anthony Jenkins AJ TS-167 <br /> cc COMPANY NAME TELEPHONE NUMBER <br /> 0- (Stockton) Med-Waste Systems, LLC (818) 998-5533 <br /> z <br /> Q ADDRESS DATE MEDICAL WASTE COLLECTED <br /> cr- <br /> I— 4079 Cherokee Rd Stockton CA 95215 06-26-2025 4:43 PM <br /> z Pharm waste 8 gallon Pharm waste 18 gallon <br /> 0 p font wt N N cont. vd.N p font. wt.N q cont wt" <br /> M p Cont. wt.N <br /> H 5 70 2 <br /> I 77 I <br /> LP 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 /> cr 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 y 06-26-2025 4:43 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 /> u 4800 E Lincoln Ave Fowler CA 93625 <br /> 0: PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED <br /> w <br /> u- TSOST-89 07-03-2025 8:06 AM 99.00 <br /> to <br /> z Q DISCREPANCY INDICATION SPACE <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 /> F-- <br /> w Jorge A 07-03-2025 8:06 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 />