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Regulated Medical Waste <br /> PageRlAaONGDOCUMENT# 8593822 <br /> CODE AREA <br /> UN3291, Regulated Medical Waste, n.o.s., 6.2, PGII 2277 <br /> ttf '_;�tTASTE <br /> SYSTEMS <br /> COMPANY NAME TELEPHONE NUMBER <br /> CHCF-California Heath Care Facility (209) 467-4661 <br /> ADDRESS <br /> O 7707 S. Austin Rd Stockton, CA 95215 <br /> H <br /> I certify that the information provided is true and correct, and that the generated materials are properly classified, described, <br /> Lu <br /> labeled/labeled/placarded; and are in proper condition for transportation according to the applicable regulations of the <br /> w packaged, p p p p g pp • 9 <br /> LU U.S. Department of Transportation. 1/ <br /> Shane Melero —er_27� 07-24-2025 2:14 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 /> H <br /> Q� ADDRESS DATE MEDICAL WASTE COLLECTED <br /> CL <br /> a 4882 McGrath St Suite 320 Ventura, CA 93003 07-24-2025 2:14 PM <br /> Ln <br /> z Pharm waste 8 gallon Pharm waste 2 gallon <br /> Q x Cont, wt.x d Cont, wt.q d Conl. wt,d q Cant. wt.d d Cont. v L x <br /> 30 362 2 9 <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 my transporter's registration and/or the privilege of utilizing State-authorized facilities. <br /> a Anthony Jenkins 07-24-2025 2:14 PM <br /> NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> TRANSFER STATION: NAME 7RA7 MBER <br /> cv NAME(S) OF PERSONS COLLECTING, TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER <br /> uj Anthony Jenkins AJ TS-167 <br /> O COMPANY NAME TELEPHONE NUMBER <br /> a_ (Stockton) Med-Waste Systems, LLC (818) 998-5533 <br /> Q ADDRESS DATE MEDICAL WASTE COLLECTED <br /> I-- 4079 Cherokee Rd Stockton CA 95215 07-24-2025 3:46 PM <br /> z Pharm waste 8 gallon Pharm waste 2 gallon <br /> O p cunt. 30 gat,x 362 p cont. 2 M.x 9 x Cont. wt.p p coat. wt.p p cunt. wt.x <br /> Q <br /> P 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 /> Ln <br /> Anthony Jenkins 14S 07-24-2025 3:46 PM <br /> cc NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> } COMPANY NAME TELEPHONE NUMBER <br /> I—J Healthwise Services (559) 834-3333 <br /> V ADDRESS <br /> < 4800 E Lincoln Ave Fowler CA 93625 <br /> w. <br /> PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED <br /> u- TSOST-89 07-31-2025 8:16 AM 371 .00 <br /> V) <br /> z <br /> Q DISCREPANCY INDICATION SPACE <br /> I <br /> h <br /> H <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 /> H <br /> w Jorge a 07-31-2025 8:16 AM <br /> I— 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 />