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Regulated Medlcal Waste <br /> MedMANIFEST# 1392797 <br /> CODE AREA <br /> Waste UN3291, Regulated Medical Waste, 5727 <br /> MANAGEMENT <br /> SatettRenabillty&e mpllance n.o.s.,6,2, PGII <br /> COMPANY NAME TELEPHONE NUMBER <br /> Windsor Elm Haven Care Center and SubAcute-5727 (209)477-4817 <br /> ADDRESS <br /> p 6940 Pacific Ave Stockton,CA 95207 <br /> � 9 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 /> Frank 03-11-2019" <br /> NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE <br /> NAME(S)OF PERSONS COLLECTING,TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER <br /> Mustafa Akbar MA 5633 <br /> COMPANY NAME TELEPHONE NUMBER <br /> U0 MedWaste Management (866)254-5105 <br /> Cr ADDRESS DATE MEDICAL WASTE COLLECTED <br /> a 5850 W 3rd Street STE 331 Los Angeles,CA 90036 03-11-2019 <br /> z Pharm Waste-12 Gal <br /> Q /[oM. M. Y[alt rYCOn4 YR.Y YCOM. Wt! Ycont wt.o <br /> or 2 0 <br /> I— <br /> >- 1 certify that the information provided above is true and correct and that only medical wastes are contained in this load.I am aware that <br /> or falsification of this manifest may result in forfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. <br /> or Mustafa Akbar �� 03-11-2019 <br /> a <br /> NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE <br /> TRANSFER STATION:NAME REGISTRATION NUMBER <br /> ry NAME(S)OF PERSONS COLLECTING,TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER <br /> Mustafa Akbar MA TS-122 <br /> Uj <br /> ¢ COMPANY NAME TELEPHONE NUMBER <br /> a MedWaste Management's Hayward Transfer Station (866)254-5105 <br /> Z ADDRESS DATE MEDICAL WASTE COLLECTED <br /> 2209 American Ave.Unit#6 Hayward CA 94545 03-11-2019 <br /> z Pharm Waste:12 Gal <br /> 0 Y[oa wL -[oM. at.Y Y — &CaM. — <br /> F- 2 0 <br /> I certify that the Information provided above is true and correct and that onlyUotreated medical wastes are contained in this load.I am aware that <br /> cc falsification of this manifest may result in forfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. <br /> Uj <br /> Lj- <br /> Ln <br /> mustsfa 03-11-2019 <br /> NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE <br /> COMPANY NAME TELEPHONE NUMBER <br /> HealthWlse Services (559)834-3333 <br /> <br /> <br /> DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED <br /> Q <br /> TSOST-89 03-12-2019 <br /> LA. <br /> DISCREPANCY INDICATION SPACE <br /> Z <br /> LU <br /> h <br /> LU 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 /> F- requirements outlined in that authorization. <br /> Dave 03-12-2019 <br /> NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE <br /> In case of emergency,call( 866 } 254-5105 (24-hr company or other emergency response group telephone) <br />