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COMPANY NAME TELEPHONE NUMBER <br />ADDRESS <br />I certify that the information provided is true and correct, and that the generated materials are properly classied , described, <br />packaged, labeled/placarded; and are in proper condition for transportation according to the applicable regulations of the <br />U.S. Department of Transportation. <br />ETADEVITATNESERPER FO ERUTANGIS)tnirP( EVITATNESERPER YNAPMOC FO EMAN <br />TRANSFER STATION:NAME REGISTRATION NUMBER <br />SLAITINIETSAWGNIDAOLNUROGNITROPSNART,GNITCELLOCSNOSREPFO)S(EMAN <br />COMPANY NAME TELEPHONE NUMBER <br />ADDRESS DATE MEDICAL WASTE COLLECTED <br />I certify that the information provided above is true and correct and that only untr eated medical wastes are contained in this load. I am aware that <br />falsication of this manifest may result in fo rfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. <br />ETADEVITATNESERPER FO ERUTANGIS)tnirP( EVITATNESERPER YNAPMOC FO EMANROTARENEG <br />COMPANY NAME TELEPHONE NUMBER <br />ADDRESS DATE MEDICAL WASTE COLLECTED <br />I certify that the information provided above is true and correct and that only untr eated medical wastes are contained in this load. I am aware that <br />falsication of this manifest may result in fo rfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. <br />ETADEVITATNESERPER FO ERUTANGIS)tnirP( EVITATNESERPER YNAPMOC FO EMANRETROPSNART YRAMIRPCOMPANY NAME TELEPHONE NUMBER <br />ADDRESS <br />DEDAOLNU/DETISOPED THGIEW LATOTDEDAOLNU/DETISOPED SAW ETSAW ETADREBMUN TIMREP <br />DISCREPANCY INDICATION SPACE <br />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 />ETADEVITATNESERPER FO ERUTANGIS)tnirP( EVITATNESERPER YNAPMOC FO EMAN <br />(24-hr company or other emergency response group telephone) <br />CODE AREA <br />YTILICAF TNEMTAERTrequirements outlined in that authorization. <br />REBMUNNOITARTSIGER <br />SLAITINIETSAW GNIDAOLNU RO GNITROPSNART ,GNITCELLOC SNOSREP FO )S(EMAN REBMUN NOITARTSIGER <br />In case of emergency, call (__________)____________________________ <br /># cont.wt. ## cont.wt. ## cont.wt. ## cont.wt. ## cont.wt. # <br /># cont.wt. ## cont.wt. ## cont.wt. ## cont.wt. ## cont.wt. # <br />MANIFEST #TRANSFER STATION / TRANSPORTER 2Page: 1 of 2 <br />UN3291, Regulated Medical Waste, n.o.s., 6.2, PGII <br />Regulated Medical Waste <br />MCMiguel Corona <br />Miguel Corona 07-30-2025 10:17 AM <br />Tatt Me Up Studio <br />4330 North Pershing Ave B-24 Stockton, CA 95207 <br />Armando <br />(209) 688-0791 <br />07-30-2025 10:17 AM <br />8614730 <br />Barnett Medical Services <br />07-30-2025 10:17 AM <br />925 321-5938 <br />P.O. Box 4436 Hayward, CA 94540 <br />(800) 748-1803 <br />6183 <br />40 Gal Bio <br />1 50.000 <br />112 Spenker Ave Modesto CA 95354 <br />Barnett Medical Services- Modesto <br />07-30-2025 1:59 PM <br />07-30-2025 1:59 PM <br />MCMiguel Corona <br />(800) 748-1803 <br />TSOST-107 <br />Miguel <br />40 Gal Bio <br />1 50.000