Laserfiche WebLink
Regulated Medical Waste <br /> MedMANIFEST# 1782736 <br /> CODE AREA <br /> Waste UN3291, Regulated Medical Waste, 5727 <br /> MANAGEMENT <br /> Safety,RellabisriaCompliance n.os.,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 /> � 1 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 /> Uj U.S.Department of Transportation. _ <br /> v <br /> Jerome 11-07-2019 <br /> NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE <br /> NAME(S)OF PERSONS COLLECTING,TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER <br /> Pao Saechin PS 5633 <br /> COMPANY NAME TELEPHONE NUMBER <br /> CC (866)MedWaste Management 254-5105 <br /> w <br /> cc ADDS DATE MEDICAL WASTE COLLECTED <br /> a 5850 W 3rd Street STE 331 Los Angeles,CA 90036 11-07-2019 <br /> z Bio Waste-44 Gal Pharm Waste-5 Gal Pharm Waste=2 Gal: <br /> < r<a e. 1 w.r 0 #c t. 4 wc.s 0 rcau 1 w.r 0 rmoc. wt.r rcooc wcr <br /> F— <br /> �.. I certify that the Information provided above is true and correct and that onlyuntreated.medical wastes are contained in this load.I am aware that <br /> falsification of this manifest may result in forfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. <br /> a Pao Saechln 11.07.2019 <br /> NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE <br /> TRANSFER STATION: NAME REGISTRATION NUMBER <br /> N NAMES)OF PERSONS COLLECTING,TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER <br /> Cr W Pao Saechin TS-122 <br /> R 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 11-07-2019 <br /> z Bio Waste-44 Gal Pharm Waste-5 Gal Pharm Waste-2 Gal <br /> 0 rtes. 1 1`0 r mne. 4 wt.r 0 r oom. 1 wt.® 0 we r r oom. we r <br /> I certify that the information provided above Is true and correct and that only untreated medical wastes are contained in this toad.i am aware that <br /> cc Lu <br /> falsification of this manifest may result in forfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. <br /> LL <br /> pao saechin 00 11-07.2019 <br /> NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE <br /> COMPANY NAME TELEPHONE NUMBER <br /> HealthWlse Services (559)834-3333 <br /> <br /> <br /> -+ PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED <br /> Q TSOST-89 11-08-2019 <br /> U- <br /> } DISCREPANCY INDICATION SPACE <br /> Z <br /> LU <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 /> Cr requirements outlined in that authorization. <br /> george 11-08.2019 <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 />