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Regulated Medical Waste PagffRA0*4G DOCUMENT s 8509068 r I , UN3291 , Regulated Medical Waste, n.o.s., 6.2, PGII 2277 cooE AREA SYSTEMS ;--` COMPANY NAME TELEPHONE NUMBER CHCF-California Heath Care Facility (209) 467-4661 ADDRESS cc O 7707 S. Austin Rd Stockton, CA 95215 I— 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 Lu U.S. Department of Transportation. , �1 Marcelino M '� 6 07-03-2025 1:48 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 I•_ x ADDRESS DATE MEDICAL WASTE COLLECTED O 4882 McGrath St Suite 320 Ventura, CA 93003 07-03-2025 1:48 PM a z Pharm waste 8 gallon Q a Cont. wt.q a Cont. wt.0 q cool, wt.9 a rant. wt.a a rant. vrt.p 1 12 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 Q falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. or Anthony Jenkins 07-03 2025 1:48 PM 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 W COMPANY NAME TELEPHONE NUMBER O a. (Stockton) Med-Waste Systems, LLC (818) 998-5533 Ln Z cc ADDRESS DATE MEDICAL WASTE COLLECTED cc I- 4079 Cherokee Rd Stockton CA 95215 07-07-2025 5:51 PM z Pharm waste 8 gallon O a cons. wt.a a cunt. wt.a a cons. wt.p a cunt. wt.p a coot. wt.p � 1 12 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 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 07-07-2025 5:51 PM cc NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE } COMPANY NAME TELEPHONE NUMBER I- Healthwise Services (559) 834-3333 J V ADDRESS u 4800 E Lincoln Ave Fowler CA 93625 Cr PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED w TSOST-89 07-10-2025 8:05 AM 12.00 z DISCREPANCY INDICATION SPACE Q H 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 :E requirements outlined in that authorization. w Jorge A 07-10-2025 8:05 AM F_ 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.