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Regulated Medical Waste <br />TRACKING DOCUMENT# 2916307 <br />Certificate of Destruction: Med-Waste Systems, LLC certifies thatthe material listed above is treated in acco <br />CODE AREA <br />UN3291, Regulated Medical Waste, <br />2275 <br />n.o.s., 6.2, PGII <br />COMPANY NAME <br />TELEPHONE NUMBER <br />DVI-Deuel Vocational Institution <br />(209) 835-4141 x5513 <br />ADDRESS <br />O <br />23500 Kasson Rd Tracy,. CA 95376 <br />I certify that the information provided is true and correct, and that the generated materials are properly classified, described, <br />� <br />Z <br />packaged, labeled/placarded; and are in proper condition for transportation according to the applicable regulations of the <br />w <br />U.S. Department of Transportation.LD <br />�1 <br />Lex Maldonado 04-01-2021 9:43 AM <br />N AM E OF COM PAN Y REPRESENTATIVE(Print) SIGNATURE O F REPRESENTATIVE DATE <br />NAME(S) OF PERSONS COLLECTIN G, TRAN5PO RTING OR ON LOADING WASTE <br />INITIALS <br />REGISTRATION NUMBER <br />Evan Lieber <br />EL <br />5039 <br />COMPANY NAME <br />TELEPHONE NUMBER <br />w <br />Med-Waste Systems, LLC <br />(818) 998-5533 <br />ADDRESS <br />DATE MEDICAL WASTE COLLECTED <br />O <br />2261 Palma Dr Unit 5 Ventura,. CA 93003 <br />04-01-2021 9:43 AM <br />a <br />N <br />Z <br />Bio 38 gallon <br />waste <br />pt <br />cant �.e <br />om. .• <br />nr .r <br />n� .x <br />ons e <br />4 54 <br />5 20 <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 />falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. <br />Q <br />` <br />a <br />Evan Lieber 04-e1-2021 9:43 AM <br />N AME OF CO M PAN Y REPRESEN TATIVE (Prin 0 SIGNATURE OF REPRESENTATIVE DATE <br />TRANSFER STATION: NAME <br />REGISTRATION NUMBER <br />NAME(S) OF PERSON S COLLECTIN G. THAN SPO RTING OR ON LOADING WASTE <br />INITIALS <br />REGISTRATION NUMBER <br />N <br />C <br />COMPANY NAME <br />TELEPHONE NUMBER <br />O <br />Q. <br />tZI <br />Z <br />ADDRESS <br />DATE MEDICAL WASTE COLLECTED <br />Q <br />F <br />Z <br />Or <br />t coot. wa <br />anons �.x <br />room M4 <br />#cant M.9 <br />load. I <br />F< <br />I certify that the information provided above Is true and correct and that only untreated medical wastes are contained In this am aware that <br />cc <br />falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. <br />ZZ <br />9 <br />N AM E O F CO M PAN Y REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br />COMPANY NAME <br />TELE PHONE NUMBER <br />Y <br />F- <br />J <br />U <br />ADDRESS <br />Q <br />PERM IT NUM BER <br />DATE WASTE WAS DEPOSITED/UNLOADEO <br />TOTAL WEIGHT DEPOSITED/UNLOADED <br />Z <br />Q <br />DISCREPANCY INDICATION SPACE <br />K <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 />requirements outlined in that authorization. <br />F - <br />Q <br />� <br />NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE <br />In case of emergency, call ( 818 ) 998-5533 (24 -hr company or other emergency response group telephone) <br />rdance with applicable local, state, and federal regulations. <br />