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Regulated Medical Waste TRACKING DOCUMENT# 2973344 Certificate of Destruction; Med-Waste Systems, LLC certifies 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 5513 ADDRESS O 23500 Kasson Rd Tracy, CA 95376 Q I certify that the information provided is true and correct, and that the generated materials are properly classified, described, w packaged, labeled/placarded; and are in proper condition for transportation according to the applicable regulations of the z U.S. Department of Transportation. /�� V\ � �tAn.P, t�� Mike Margullis U 04-22-20219:44 AM N AM E OF COM PANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE NAME(S)OF PERSON S COLLECTING, IRAN SPO RTING OR ON LOADING WASTE INITIALS REGISTRATION NUMBER Evan Lieber EL 5039 COMPANY NAME TELEPHONE NUMBER Med-Waste Systems, LLC (818) 998-5533 I- of ADDRESS DATE MEDICAL WASTE COLLECTED a 2261 Palma Dr Unit 5 Ventura, CA 93003 04-22-20219:44 AM Z DQo 38 gallon2 , on,. MA 24 F 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 �I 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 L ` 04-22-2021 9:44 AM N AM E O F CO M PAN Y REPRESEN TATIVE(Prin0 SI G N ATURE O F REPRESEN TATIVE DATE TRANSFER STATION: NAME REGISTRATION NUMBER NAM EIS) O F PERSO N S COLLECTIN G, TRANSPORTIN G O R ON LOADIN G WASTE INITIALS REGISTRATION NUMBER N z COMPANY NAME TELEPHONE NUMBER O a Z DATE MEDICAL WASTE COLLECTED Q ADDRESS F- O am. .r om a nt + m. a#Cont n I- NN 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 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 F N AM E O F CO M PAN Y REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE COMPANY NAME TELEPHONE NUMBER H Healthwise Services (559) 834-3333 lJ ADDRESS < 4800 E Lincoln Ave Fowler CA 93625 PERMIT NUMBER DATEWASTEWAS DEPOSITEDION LOADED TOTAL WEIGHT DEPOSITED/UNLOADED TSOST-89 04-22-2021 1:06 PM 24.00 Z DISCREPANCY INDICATION SPACE Q rr H Z (certify that) have been authorized to accept untreated medical wastes and that l have received the above indicated wastes in accordance with the � requirements outlined in that authorization. G / 04-22-2021 1:06 PM W Christian Rivera I" 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) that the material listed above is treated In accordance with applicable local, state, and federal regulations.