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Regulated Medical Waste <br /> Med <br /> MANIFESTO 1759260 <br /> CODE AREA <br /> Waste UN3291, Regulated Medical Waste, 5727 <br /> MANAGEMENT <br /> Solely, <br /> fiellehiittYacompliance 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 /> Cr 6940 Pacific Ave Stockton,CA 95207 <br /> ,s I certify that the information provided 6s true and correct,and that the generated materials are property 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. q - <br /> Julio -1 ^ '� 10.24.2019 <br /> NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE <br /> NAME(S)OF PERSONS COLLECTING,TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER <br /> Pao Saechin PS 5633 <br /> COMPANY NAME TELEPHONE NUMBER <br /> cc MedWaste Management (866)254-5105 <br /> Lu <br /> 9= ADDRESS DATE MEDICAL WASTE COLLECTED <br /> 4 5850 W 3rd Street STE 331 Los Angeles,CA 90036 10-24-2019 <br /> z Pharm Waste;5 Gal <br /> /COM. WC/ <br /> 4 0 wr r wr.r/coni. tl COM. vR/ r cone. wt.r <br /> I certify that the information provided above is true and correct and that only untrIated medical wastes are contained in this load.l am aware that <br /> ,Cr¢ falsification of this manifest may result in forfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. <br /> Pao Seechin 10-24-2019 <br /> NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE <br /> TRANSFER STATION: NAME REGISTRATIONNUMBER <br /> /y NAME(S)OF PERSONS COLLECTING,TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER <br /> w Pao Saechin PS TS-1.22 <br /> E 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 Ha and CA 94545 1 10.24-2019 <br /> z Pharm Waste;5 Gal <br /> train. wn.r /cone. wi./ /cone wi.r /cont. w.r /caN. wet <br /> 4 0 <br /> HI 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 transponees registration and/or the privilege of utilizing State-authorized facilities. <br /> LU <br /> 11-0 <br /> Q pao saechin 10-24-2019 <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 /> v TSOST-89 10-25-2019 <br /> I— DISCREPANCY INDICATION SPACE <br /> Z <br /> ua <br /> F— <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 /> i— <br /> requirements outlined in that authorization. <br /> angel Z 10-25-2019 <br /> NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE <br /> In case of emergency,call L__!66 ) 254-5105 (24-hr company or other emergency response group telephone) <br />