Laserfiche WebLink
Regulated Medical Waste <br /> PagffR/1 GANG DOCUMENT N 8622511 <br /> - CODE AREA <br /> UN3291, Regulated Medical Waste, n.o.s., 6.2, PGII 2277 <br /> A, WASTE <br /> E SYSTEMS <br /> COMPANY NAME TELEPHONE NUMBER <br /> CHCF-California Heath Care Facility (209) 467-4661 <br /> ADDRESS <br /> cc <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 /> Lu U.S. Department of Transportation. <br /> Marcelino M �"'�"�' � � 07-31-2025 1:57 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 /> I- <br /> ADDRESS DATE MEDICAL WASTE COLLECTED <br /> 0 4882 McGrath St Suite 320 Ventura, CA 93003 07-31-2025 1:57 PM <br /> a <br /> to <br /> z Pharm waste 2 gallon Pharm waste 8 gallon <br /> ¢ p cant. wt.p p cant. vR,p To <br /> coot. wt.p p coot, wt.p N coot. wt.N <br /> � 2 8 21 245 <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 /> Qfalsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. <br /> cc Cl- Anthony Jenkins 07-31-2025 1:57 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 /> Lu Anthony Jenkins AJ TS-167 <br /> O COMPANY NAME TELEPHONE NUMBER <br /> CL (Stockton) Med-Waste Systems, LLC (818) 998-5533 <br /> Z ADDRESS DATE MEDICAL WASTE COLLECTED <br /> F— 4079 Cherokee Rd Stockton CA 95215 08-01-2025 5:01 PM <br /> z Pharm waste 2 gallon Pharm waste 8 gallon <br /> O p cant. wt,p p cant, rt.p p coot. wt.p p cant. WI.p p cant. wt.p <br /> F 2 1 8 21 <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 /> 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 /> QAnthony Jenkins 08-01-2025 5:01 PM <br /> cc <br /> NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br /> } COMPANY NAME TELEPHONE NUMBER <br /> F— Healthwise Services (559) 834-3333 <br /> J <br /> lJ ADDRESS <br /> < 4800 E Lincoln Ave Fowler CA 93625 <br /> LL <br /> PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED <br /> u-to TSOST-89 08-07-2025 8:44 AM 253.00 <br /> z¢ DISCREPANCY INDICATION SPACE <br /> F- <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 /> requirements outlined in that authorization. <br /> F- <br /> w Jorge A 08-07-2025 8:44 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 />