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Regulated Medical Waste TRACKING DOCUMENT# 2878725 Certificate of Destruction: Med-Waste Systems, LLC cert CODE AREA UN3291, Regulated Medical Waste, 2275 n.o.s., 6.2, PGII v:* �Aaw.. COMPANY NAME TELEPHONE NUMBER DVI-Deuel Vocational Institution (209) 835-4141 x X5513 ADDRESS p 23500 Kasson Rd Tracy, CA 95376 I certify that the information provided is true and correct, and that the generated materials are properly classified, described, � 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 03-18-2021 9:39 AM N AM E OF COM PANY REPRESENTATIVE(Print) SIGNATURE O F REPRESENTATIVE DATE NAMES) OF PERSON S COLLECTING, TRAN SPORTING OR UN LOADING WASTE INITIALS REGISTRATION NUMBER Evan Lieber EL 5039 COMPANY NAME TELEPHONE NUMBER w Med-Waste Systems, LLC (818) 998-5533 K ADDRESS DATE MEDICAL WASTE COLLECTED 0 2261 Palma Dr Unit 5 Ventura, CA 93003 03-18-2021 9:39 AM Z Bio 38 gallon L MA os .r oOc .a n. .a ant. .® 1 23 F y I certify that the information provided above Is true and correct and that only untreated medical wastes are contained in this load. l am aware that falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. Q � L a Evan Lieber 03-18-2021 9:39 AM N AM E O F C O M PAN Y REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE TRANSFER STATION: NAME REGISTRATION NUMBER NAMES) OF PERSO N S CO LLECTING, TRANSPORTING ORUNLOADIN G WASTE INITIALS REGISTRATION NUMBER N z of COMPANY NAME TELEPHONE NUMBER O Q ADDRESS DATE MEDICAL WASTE COLLECTED 2 O8 ccnt. MA 9COnL MA =L 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 vQ~i M falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. Z � NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE COMPANY NAME TELEPHONE NUMBER } H J V ADDRESS M PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIG HT DEPOSITED/UNLOADED N Z Q DISCREPANCY INDICATION SPACE M F Z 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 w g requirements outlined in that authorization. H Q � 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) ifies that the material listed above Is treated in accordance with applicable local, state, and federal regulations.