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Regulated Medical Waste TRACKING DOCUMENT 2934964 Certificate of Destruction: Med-Waste Systems, LLC certifies that the material listed above is treated in accordance with applicable local, state, and federal regulations. CODE AREA UN3291, Regulated Medical Waste, 2275 n.o.s., 6.2, PGII 7R COMPANY NAMETELEPHONE NUTRIER DVI-Deuel Vocational Institution (209) 835-4141 x 5513 ADDRESS O 23500 Kasson Rd Tracy, CA 95376 F � 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. V� \ Mike Margullis Y '^'" 04-08-2021 9:32 AM NAME O F COM PANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE NAME(S) OF PERSON S CO LLECTIN G, TRAIN SPO RTING OR ON LOADING WASTE INITIALS REGISTRATION NUMBER Evan Lieber EL 5039 COMPANY NAME TELEPHONE NUMBER w Med-Waste Systems, LLC (818) 998-5533 K DATE MEDICALWASTE COLLECTED ADDRESS 0 2261 Palma Dr Unit 5 Ventura, CA 93003 04-08-2021 9:32 AM Z Bio 38 gallonPharm waste Sharps container(WL#s) oat .a.a m. a 0t 6 m. c WL JoCa ` d 1 12 1 7 3 I certify that the information provided above is true and correct and that onlyUntreated medical wastes are contained in this load. I 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. a Evan Lieber ` 04-08-20219:32 AM N AM E OF CO M PANY REPRESENTATIVE (Print) SIG NATURE OF REPRESENTATIVE DATE TRANSFER STATION: NAME REGISTRATION NUMBER NAMES) O F PERSONS COLLECTIN G, TRANSPORTIN G O R ON LOADIN G WASTE INITIALS REGISTRATION NUMBER N K bc COMPANY NAME TELEPHONE NUMBER O Ct. Z DATE MEDICAL WASTE COLLECTED 0c ADDRESS F- O om. a �r. r oo� + m.WE.eI COAL.a F- 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 falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. w Z Z NAME O F COM PANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE F COMPANYNAME TELEPHONE NUMBER y H U ADDRESS Q LL x PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED Z DISCREPANCY INDICATION SPACE Q K F- H z I certify that I have been authorized to accept untreated medical wastes and that) have received the above Indicated wastes in accordance with the requirements outlined in that authorization. F - Q w z F' NAME OF COMPANY REPRESENTATIVE(Print) SIG NATURE OF REPRESENTATIVE DATE In case of emergency, call ( 818 ) 998-5533 (24 -hr company or other emergency response group telephone) Certificate of Destruction: Med-Waste Systems, LLC certifies that the material listed above is treated in accordance with applicable local, state, and federal regulations.