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Regulated Medical Waste <br />TRACKING DOCUMENT# 2878725 <br />Certificate of Destruction: Med-Waste Systems, LLC certifies that the <br />CODE AREA <br />UN3291, Regulated Medical Waste, <br />2275 <br />VM564�0� <br />n.o.s., 6.2, PGII <br />ya <br />COMPANY NAME <br />TELEPHONE NUMBER <br />DVI-Deuel Vocational Institution <br />(209) 835-4141 x X5513. <br />ADDRESS <br />p <br />23500 Kasson Rd Tracy, CA 95376 <br />I certify that the information provided is true <br />and correct, and that the generated materials are properly classified, described, <br />W <br />packaged, labeled/placarded; and are in proper condition for transportation according to the applicable regulations of the <br />Z <br />U.S. Department of Transportation. <br />Jaime Moffatt <br />03-18-2021 9:39 AM <br />NAM E O F COMPANY REPRESENTATIVE(Print) <br />SIGNATURE OF REPRESENTATIVE DATE <br />NAMES) OF PERSON 5 COLLECTING, IRAN SPO RTING <br />O R UN LOADIN G WASTE <br />INITIALS <br />REGISTRATION NUMBER <br />Evan Lieber <br />EL <br />5039 <br />COMPANY NAME <br />TELEPHONE NUMBER <br />oc <br />Med-Waste Systems, LLC <br />(818) 998-5533 <br />¢ <br />ADDRESS <br />DATE MEDICAL WASTE COLLECTED <br />0 <br />2261 Palma Dr Unit 5 Ventura, CA 93003 <br />03-18-2021 9:39 AM <br />a <br />N <br />Z <br />Bio 38 gallon <br />I cont. .. <br />om. + <br />ter. .+ <br />nr <br />+ <br />¢ <br />1 23 <br />F <br />> <br />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 <br />z <br />falsification of this tracking document may result in <br />forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. <br />Q <br />L <br />a <br />Evan Lieber <br />03-18-2021 9:39 AM <br />NAME OF COMPANY REPRESENTATIVE(Print) <br />SIG N ATURE O F REPRESENTATIVE DATE <br />TRANSFER STATION: NAME <br />REGISTRATION NUMBER <br />NAMES) O F PERSON S COLLECTIN G, TRANSPORTIN G <br />OR UN LOADING WASTE <br />INITIALS <br />REGISTRATION NUMBER <br />N <br />w <br />Evan Lieber <br />EL <br />¢ <br />COMPANY NAME <br />TELEPHONE NUMBER <br />n <br />(Stockton) Med-Waste Systems, LLC <br />(818) 998-5533 <br />ADDRESS <br />DATE MEDICAL WASTE COLLECTED <br />4079 Cherokee Ln Stockton CA 95215 <br />03-18-2021 10:08 AM <br />Z <br />Bio 38 gallon <br />0 <br />oar. <br />nr. <br />ani + <br />F <br />1.e 23 <br />tiI <br />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 <br />w <br />falsification of this tracking document may result in <br />forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. <br />Evan Lieber <br />`� 03-18-2021 10:08 AM <br />aZ <br />F <br />NAME OF COMPANY REPRESENTATIVE (Print) <br />SIG N ATURE O F REPRESEN TATIVE DATE <br />COMPANY NAME <br />TELEPHONE NUMBER <br />} <br />77(559)834-3333 <br />F_ <br />Healthwise Services <br />lJ <br />ADDRESS <br />< <br />4800 E Lincoln Ave Fowler CA 93625 <br />PERMIT NUMBER <br />DATE WASTE WAS DEPOSITED/UNLOADED <br />TOTAL WEIGHT DEPOSITED/UNLOADED. <br />TSOST-89 <br />03-19-2021 11:36 AM <br />23.00 <br />Z <br />Q <br />DISCREPANCY INDICATION SPACE <br />rr <br />H <br />F <br />Z <br />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 <br />W <br />g <br />requirements outlined in that authorization. <br />E- <br />< <br />`T V 11:36 AM <br />Javier Regis <br />k/ ie' ✓ 03-19-2021 <br />� <br />NAME OF COMPANY REPRESENTATIVE (Pdnt) <br />SIG NATURE OF REPRESENTATIVE DATE <br />In <br />case of emergency, call ( 818 ) 998-5533 <br />(24 -hr company or other emergency response group telephone) <br />material listed above is treated in accordance with applicable local, state, and federal regulations. <br />