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o Regulated Medical Waste <br />TRACKING DOCUMENT 2916307 <br />Certificate of Destruction: Med-Waste Systems, LLC certifies that the material <br />CODE AREA <br />7 UN3291, Regulated Medical Waste, <br />2275 <br />n cl.s., 6.2, PGII <br />�n.gy„e. mad, <br />COMPANY NAME <br />TELEPHONE NUMBER <br />DVI-Deuel Vocational Institution <br />(209) 835-4141 x 5513 <br />ADDRESS <br />p <br />23500 Kasson Rd Tracy, CA 95376 <br />a <br />I certify that the information provided is true 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 />Lex Maldonado 04-01-2021 9:43 AM <br />NAM E OF COM PANY REPRESENTATIVE(Print) SIGN ATURE O F REPRESENTATIVE DATE <br />NAME(S) OF PERSONS COLLECTING, TRANSPORTING OR UNLOADING 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 />¢ <br />ADDRESS <br />DATE MEDICAL WASTE COLLECTED <br />a <br />2261 Palma Dr Unit 5 Ventura, CA 93003 <br />04-01-2021 9:43 AM <br />Z <br />Bio 38 gallon <br />Pharm waste <br />can .4 <br />n <br />�� r <br />or , <br />54 <br />5 20 <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 />�I <br />2 <br />falsification ofthis tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. <br />` <br />Evan Lieber 04-01-20219:43 AM <br />a <br />NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE <br />TRANSFER STATION: NAME <br />REGISTRATION NUMBER <br />NAME(S) OF PERSONS COLLECTIN G, TRAIN SPORTING O R UN LOADING WASTE <br />INITIALS <br />REGISTRATION NUMBER <br />N. <br />Evan Lieber <br />EL <br />K <br />COMPANY NAME <br />TELEPHONE NUMBER <br />(Stockton) Med-Waste Systems, LLC <br />(818)998-5533 <br />ADDRESS <br />DATE MEDICAL WASTE COLLECTED <br />F <br />4079 Cherokee Rd Stockton CA 95215 <br />04-02-2021 7:56 AM <br />z <br />NO 38 gallon <br />Pharm waste <br />O <br />opt <br />.54 <br />dAL . <br />an` e <br />m .w <br />nL a <br />4 <br />5 20 <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 />U! <br />falsification of this tracking document may result in forfeiture of mytransporter's registration and/or the privilege of utilizing State -authorized facilities. <br />Z <br />Evan Lieber 04-02-20217:56 AM <br />z <br />I.. <br />NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE <br />COMPANY NAME <br />TELEPHONE NUMBER <br />Healthwise Services <br />(559) 834-3333 <br />U <br />ADDRESS <br />w <br />4800 E Lincoln Ave Fowler CA 93625 <br />w <br />PERMIT NUMBER <br />DATE WASTE WAS DEPOSITED/UNLOADED <br />TOTAL WEIGHT DEPOSITED/UNLOADED <br />TSOST-89 <br />04-05-2021 11:29 AM <br />74.00 <br />Z <br />Q <br />DISCREPANCY INDICATION SPACE <br />K <br />F- <br />H <br />Z <br />(certify that) have been authorized to accept untreated medical wastes and thathave received the above indicated wastes in accordance with the <br />2 <br />requirements outlined in that authorization. <br />E- <br />< <br />-y/c �A 04-05-2021 11:29 AM <br />Javier Regis <br />F <br />NAME OF COMPANY REPRESENTATIVE(Print) SIGN ATURE OF REPRESENTATIVE DATE <br />Incase of emergency, call ( 818 ) (24 -hr company or other emergency response group telephone) <br />_R98-5533 <br />listed above is treated in accordance with applicable local, state, and federal regulations. <br />