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82-579 Fleming Way Suite F Tel: 760.347,4422 Fax. 760.406.5975 Indio, CA 92201 NATIONAL GREEN GAS For Generations to Come F A`' TRACKING NO: WASIECLASS 6.2 UN3291 California MEDICAL WASTE TRACKING DOCUMENT PG.r1 Medical Waste Emergency telephone number:877-4124422 Generator information This is to certify that the materials described below are properly classified, packaged,marked and labeled and are in proper condition for transportation in accordance with the applicable regulations of the O ^ � United States Department of Transportation. W � NAME OF COMPANY REPRESENTATIVE(Print) z SIGNATURE OF REPRESENTATIVE 1L] DATE Type of Was ❑`BiolSharps ❑ Trace-Chemo E] Pathological ❑ Pharmaceutical ❑ Other Number of containers collected Est.Weight Actual Net Wt 18G 2 G 38 G 48G 96 G OTHER Comments Deputy Weighmaster's Intials ❑` ❑Other ❑OTHER: c� National Green Gas,LLC 82-579 Fleming Way, "' NAME OFCOMPANYREPRESENTATIVE(Print) o Suite F ZIndio, CA 92201 SIGNA TURE OF REPRESENTA TIVE Q Tel: 760.347.4422 ti Transporter Registration#:6031 Date of Transportation OF-1El ❑OTHER: National Green Gas,LLC National Green Gas,LLC 82-579 Fleming Way, 16-457 Avenue 241/2 NAME OF COMPANY REPRESENTATIVE(Print) CO) Suite F Chowchilla, CA 93610 w Indio, CA 92201 TS-7 z Tel: 760.347.4422 SIGNATURE OF REPRESENTATIVE TS/OST-99 a„. Date Received in Transfer ❑ Other ❑OTHER: CERTIFICATE OFDISTRUCTION❑ The signature below certifies the above documented waste was received, A National Green Gas,LLC treated and disposed of in accordance with all local,State and Federal 82-579 Fleming Way, Regulations and following all conditions within our permit,on dates U Suite F documented. Indio, CA 92201 Tel. 760.347.4422 TS/OST-99 QTreatment Type:Ozonation NAME OF COMPANY REPRESENTATIVE(Print) W SIGNATURE OF REPRESENTATIVE DATE RECEIVED Date of Treatment