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Regulated Medical Waste MedMANIFEST# 1944969 CODE AREA Waste UN3291, Regulated Medical Waste, 5727 MANAGEMENT Safety, itanallutilae mpliaace n.o.s.,6.2, PGII COMPANY NAME TELEPHONE NUMBER Windsor Elm Haven Gare Center and SubAcute-5727 (209)477.4817 ADDRESS p 6940 Pacific Ave Stockton,CA 95207 I certify that the information provided is true and correct,and that the generated materials are properly classified,described, cc Z packaged,labeled/placarded;and are in proper condition for transportation according to the applicable regulations of the Lu U.S.Department of Transportation. —, Ja `- 02-06-2020 NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE NAME(S)OF PERSONS COLLECTING,TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER Pao Saechin PS 5633 COMPANY NAME TELEPHONE NUMBER cc MedWaste Management (866)254-5105 LU ¢ ADDRESS DATE MEDICAL WASTE COLLECTED Q. 5850 W 3rd Street STE 331 Los Angeles,CA 90036 02-06-2020 z Blo Waste-44 Gal Pharm Waste-8 Ga! Pharm Waste-5 Gal < «� 1 .«0 «� 2 0 12 « ®cc r 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 cc falsification of this manifest may result in forfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. n0. Pao Saechin 02-06-2020 NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE TRANSFER STATION:NAME REGISTRATION NUMBER N NAME(S)OF PERSONS COLLECTING,TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER w Pao Saechin PS TS-122 COMPANY NAME TELEPHONE NUMBER V1 MedWaste Management's Hayward Transfer Station (866)254-5105 Z ADDRESS DATE MEDICAL WASTE COLLECTED 2209 American Ave.Unit#6 Ha and CA 94545 02-06.2020 z Bio Waste-44 Ga! Pharm Waste-8 Gal Pharm Waste-5 Gal 0 «calf. 1 to® «can. 2 1 wt*' 0 1 #.a 12 " 0 «cont, wt.« «can an« 4 (—,, I 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 LU falsification of this manifest may result in forfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. Z pao saechin P 02-06-2020 cr NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE COMPANY NAME TELEPHONE NUMBER HealthWise Services (559)834-3333 —i PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED ]--TOTAL WEIGHT DEPOSITED/UNLOADED < TS®ST-89 02-07-2020 W DISCREPANCY INDICATION SPACE Z LU F-- c;i 1 certify that 1 have been authorized to accept untreated medical wastes and that I have received the above indicated wastes in accordance with the requirements outlined in that authorization. george C 02-07-2020 NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE E:case:o:f:emergency,call( 866 ) 254-5105 (24-hr company or other emergency response group telephone)