COMPLIANCE INFO_2015-2021 - Laserfiche WebLink

Home Browse Search

Regulated Medical Waste =WITRACKING DOCUMENT# 2619269 Certificate of Destruction: Med-Waste Systems, LLC certifies that the material CODE AREA UN3291, Regulated Medical Waste, 2275 n.o.s., 6.2, PGII COMPANY NAME TELEPHONE NUMBER DVI-Deuel Vocational Institution (209) 835-4141 x X5513 ADDRESS p 23500 Kasson Rd Tracy, CA 95376 H Q 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 U.S. Department of Transportation. Jaime Moffatt 02-25-2021 9:13 AM N AM E OF COM PAN Y REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE N AM E(S) OF PERSONS COLLECTING, TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER Evan Lieber EL 5039 COMPANY NAME TELEPHONE NUMBER w Med-Waste Systems, LLC (818) 998-5533 CC ADDRESS DATE MEDICAL WASTE COLLECTED 2261 Palma Dr Unit 5 Ventura, CA 93003 02-25-2021 9:13 AM Q_ U1 Bio 38 gallon Pharm waste ont. w.r one . t. .a t a ons .. oc 5 112 5 39 H > 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 Cc falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege ofutilizing State -authorized facilities. a Evan Lieber 02-25-2021 9:13 AM NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE TRANSFER STATION: NAME REGISTRATION NUMBER NAME(S) O F PERSONS COLLECTING, TRAN SPO RTING O R UN LOADIN G WASTE INITIALS REGISTRATION NUMBER COMPANY NAME TELEPHONE NUMBER O a Z Q ADDRESS DATE MEDICAL WASTE COLLECTED CC F Z O nt. .a ont. a nt. . nL . ont .. H NI 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 Q: falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. in z Q � NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE COMPANY NAME TELEPHONE NUMBER Y 1^- Healthwise Services (559) 834-3333 J V ADDRESS LL 4800 E Lincoln Ave Fowler CA 93625 PERMIT NUM BER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED LL TSOST-89 02-25-2021 11:23 AM 151.00 Z Q DISCREPANCY INDICATION SPACE K H F Z I certify that I have been authorized to accept untreated medical wastes and that I have received the shove indicated wastes in accordance with the W, requirements outlined in that authorization. I— y w Rafael Carrillo 02-25-2021 11:23 AM F' NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE In case of emergency, call ( 818 1 998-5533 (24 -hr company or other emergency response group telephone) listed above is treated in accordance with applicable local, state, and federal regulations.