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Regulated Medical Waste TRACKING DOCUMENT# 2897666 Certificate of Destruction: Med-Waste Systems, LLC certifies that 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 a Icertify that the information provided is true and correct, and that the generated materials are properly classified, described, packaged, labeled/placarded; and are in proper condition for transportation according to the applicable regulations of the Z U.S. Department of Transportation. 1�tT�J Gena Cherry) ' 03-25-2021 9:54 AM NAME O F COM PANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE NAME(S) OF PERSON S COLLECTING, TRAN SPORTING O R UN LOADING WASTE INITIALS REGISTRATION NUMBER Evan Lieber EL 5039 COMPANY NAME TELEPHONENUMBER DO Med-Waste Systems, LLC (818) 998-5533 ¢ ADDRESS DATE MEDICAL WASTE COLLECTED a 2261 Palma Dr Unit 5 Ventura, CA 93003 03-25-20219:54 AM Blo 38 gallon #contZ ., nnc < nnr , nc ® MAH one 0 0 } Icertify that the information provided above is true and correct and that only untreated medical wastes are contained in this load. lam aware that s falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. Q a Evan Lieber 03-25-2021 9:54 AM NAMEOF COMPANY REPRESENTATIVE(Print) SIGNATUREOF REPRESENTATIVE DATE TRANSFER STATION: NAME REGISTRATION NUMBER NAME(S) O F PERSONS COLLECTIN G. TRANSPORTIN G OR ON LOADIN G WASTE INITIALS REGISTRATION NUMBER N K lY COMPANYNAME TELEPHONE NUMBER O a Q ADDRESS DATE MEDICAL WASTE COLLECTED K F- O ons W.8T ntant M.f Ncont a nt .a N 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 m falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized fadlities. Lu in ZZ F N AM E D F C O M PAN Y REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE COMPANY NAME TELEPHONE NUMBER y F- U ADDRESS Q K PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTALWEIGHT DEPOSITED/UNLOADED Z DISCREPANCY INDICATION SPACE ococ 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 grequirements outlined in that authorization. F- LuLu 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) the material listed above Is treated in accordance with applicable local, state, and federal regulations.