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Regulated Medical Waste TRACKING DOCUMENT# 2860352 Certificate of Destruction: Med-Waste Systems, LLC certifies that the CODE AREA UN3291, Regulated Medical Waste, 2275 n.o.s., 6.2, PGI( COMPANY NAME TELEPHONE NUMBER DVI-Deuel Vocational Institution (209) 835-4141 x X5513 ADDRESS p 23500 Kasson Rd Tracy, CA 95376 F 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 03-11-2021 10:14 AM NAME O F COM PAN Y REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE NAME(S) OF PERSON 5 COLLECTIN G, TRAN SPORTIN G O R UNLOADING WASTE IN RIALS REGISTRATION NUMBER Evan Lieber EL 5039 COMPANYNAME TELEPHONE NUMBER of Med-Waste Systems, LLC (818) 998-5533 Of ADDRESS DATE MEDICAL WASTE COLLECTED 2261 Palma Dr Unit 5 Ventura, CA 93003 03-11-2021 10:14 AM CL ti Z Blo 38 gallon w,.e i. . ore, a oe r �c �i. 0 0 f > (certify that the information provided above is true and correct and that only unheated medical wastes are contained in this load. lam aware that falsification of this hacking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. Q a Evan Lieber ` 03-11-202110:14 AM NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE TRANSFER STATION: NAME REGISTRATION NUMBER NAME(5) O F PERSON S COLLECTIN G. TRAN SPORTIN G O R UN LOADING WASTE INITIALS REGISTRATION NUMBER N 5 it COMPANY NAME TELEPHONE NUMBER O a Z Z ADDRESS DATE MEDICALWASTE COLLECTED 5 F - Z O WLI TU cant. mt I I cont MA F- 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 vv.t ¢ falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. z F NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE COMPANY NAME TELEPHONE NUMBER > F V ADDRESS Q PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED wU. Z Z DISCREPANCY INDICATION SPACE F- F - Z I certify that l have been authorized to accept untreated medical wastes and that l have received the above indicated wastes in accordance with the � requirements outlined in that authorization. r a w r F- NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE In case of emergency, call( 818 )998-5533 (24 -hr company or other emergency response group telephone) material listed above Is treated in accordance with applicable local, state, and federal regulations.