Laserfiche WebLink
Regulated Medical Waste <br /> MedMANIFEST k 1832277 <br /> CODE AREA <br /> Waste UN3291, Regulated Medical Waste, 5727 <br /> MANAGEMENT <br /> Safatir,twoublift a comillence n.os.,6.2, PGII <br /> COMPANY NAME 7(209)477-4817 <br /> HONE NUMBER <br /> Windsor Elm Haven Care Center and SubAcute-5727 <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 /> 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 /> Pauline l 12-05-2019 <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 /> MedWaste Management (866)254-5105 <br /> LU <br /> cr ADDRESS DATE MEDICAL WASTE COLLECTED <br /> a 5850 W 3rd Street STE 331 Los Angeles,CA 90036 12-05-2019 <br /> z Bio Waste-44 Gal Pharm Waste-5 Gal Pharm Waste 2 Gal Pharm Waste-8 Gal <br /> 1 ® 4 ® ® 1 �. ® r IoM.1 ,�.. ® <br /> I— <br /> y 1 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 <br /> falsification of this manifest may result in forfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. <br /> Pao Saechin 12.05.2019 <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 /> w Pao Saechin PS TS-122 <br /> COMPANY NAME TELEPHONE NUMBER <br /> aMedWaste Management's Hayward Transfer Station (866)254-5105 <br /> ADDRESS DATE MEDICAL WASTE COLLECTED <br /> 2209 American Ave.Unit#6 Hayward CA 94545 12-05-2019 <br /> z Bio Waste-44 Gal Pharm Waste-5 Gal Pharm Waste-2 Gal Pharm Waste-8 Gal <br /> I-- <br /> r<wo. 1 va r® rcat 4 m.r 0 rCOK 1 L1 0 8C C.1 wtr 0 IML urt.r <br /> I certify that the information provided above Is true and correct and that only untreatgd medical wastes are contained in this load.I am aware that <br /> falsification of this manifest may result in forfeiture of my transportees registration and/or the privilege of utilizing State-authorized facilities. <br /> -110 <br /> LA saechin 12-05.2019 <br /> 9H NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE <br /> COMPANY NAME TELEPHONE NUMBER <br /> HealthW(se Services (559)834-3333 <br /> <br /> <br /> PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED <br /> a <br /> TSOST-89 12-06-2019 <br /> I— DISCREPANCY INDICATION SPACE <br /> Z <br /> w <br /> 2 <br /> i— <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 /> F requirements outlined in that authorization. <br /> george 15� 12-06.2019 <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 />