Laserfiche WebLink
Regulated Medical Waste <br /> MedMANIFEST# 1300453 <br /> CODE AREA <br /> .Waste UN3291, Regulated Medical Waste, 5727 <br /> MANAGEMENT <br /> Salon, <br /> 8e silty&C pgance 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 /> I certify that the information provided is true and correct,and that the generated materials are properly classified,described, <br /> or <br /> Z packaged,labeled/placarded;and are in proper condition for transportation according to the applicable regulations of the <br /> U.S.Department of Transportation, <br /> Julio <br /> 01-07-2019 <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 /> Cr W MedWaste Management (866)254-5105 <br /> I.- ADDRESS DATE MEDICAL WASTE COLLECTED <br /> 0 5850 W 3rd Street STE 331 Los Angeles,CA 90036 01-07-2019 <br /> ®. <br /> z Pharm Waste-5 Gal Pharm Waste-12 Gal Pharm Waste-2 Gal <br /> < r can. 2nc 2 wt.® ® r cont 2 en.r ® r cont vrt.r r can. vrt.r <br /> F- <br /> y� i certify that the information provided above is true and correct and that oniytl medical wastes are contained in this load.i am aware that <br /> ,r falsification of this manifest may result in forfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. <br /> Mustafa Akbar _ 01-07-2019 <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 Mustafa Akbar MA TS-122 <br /> a~c COMPANY NAME TELEPHONE NUMBER <br /> a MedWaste Management's Hayward Transfer Station (866)254.5105 <br /> Z ADDRESS DATE MEDICAL WASTE COLLECTED <br /> Qc <br /> 2209 American Ave.Unit#6 Ha and CA 94545 1 01.07-2019 <br /> z Pharm Waste;5 Gal Pharm Waste-12 Gal Pharm Waste-2 Gal <br /> 0 w mnL 2 " r oan. 2 wn.r 0 s corn. 2 " 0 room. "t r room — <br /> NI 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 /> cc falsification of this manifest may result In forfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. <br /> LU <br /> LL <br /> Z mustafa 01.07-2019 <br /> NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE <br /> COMPANY NAME TELEPHONE NUMBER <br /> HealthWise Services (559)834-3333 <br /> <br /> <br /> - PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED <br /> TSOST-89 01-08-2019 <br /> I <br /> 1.,- DISCREPANCY INDICATION SPACE <br /> Z <br /> US <br /> w 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 /> requirements outlined in that authorization. <br /> Dave /1 01.08-2019 <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 />