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Regulated Medical Waste PagffR/✓mt NG DOCUMENT N 8534473 { CODE AREA r _ UN3291, Regulated Medical Waste, n.o.s., 6.2, PGII 2277 ` t: SYSTEMS `z COMPANY NAME TELEPHONE NUMBER CHCF-California Heath Care Facility (209) 467-4661 ADDRESS Cr 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. � Marcelino M 07-10-2025 12:10 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 F- CC ADDRESS DATE MEDICAL WASTE COLLECTED O 4882 McGrath St Suite 320 Ventura, CA 93003 07-10-2025 12:10 PM a Z Pharm waste 8 gallon ¢ A cant. wt.A W cont. wt,M 0 cent. wt.A R cont. wt,4 4 cont. VA.N 12 122 V-- > 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 ¢ falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. Cr Anthony Jenkins 07-10-2025 12:10 PM NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE TRANSFER STATION: NAME REGISTRATION NUMBER N NAME(S) OF PERSONS COLLECTING, TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER cc Lu Anthony Jenkins AJ TS-167 COMPANY NAME TELEPHONE NUMBER O N (Stockton) Med-Waste Systems, LLC (818) 998-5533 z ADDRESS DATE MEDICAL WASTE COLLECTED I- 4079 Cherokee Rd Stockton CA 95215 07-10-2025 4:12 PM Z Pharm waste 8 gallon O M Cont. Wt.N #cont. wt.tl 0 cont. wt.N N cont. wt.8 N cont. wt.N 1= 12 122 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 w falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. QAnthony Jenkins 07-10-2025 4:12 PM f NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE r COMPANY NAME TELEPHONE NUMBER I— Healthwise Services (559) 834-3333 _l U ADDRESS < 4800 E Lincoln Ave Fowler CA 93625 Cr PERMIT NUMBER TD7ATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED w u- TSOST-89 -17-2025 8:11 AM 122.00 to z DISCREPANCY INDICATION SPACE F I— 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. F- w Jorge A 07-17-2025 8:11 AM 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.