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Regulated Medical Waste TRACKING DOCUMENT# 2992517 �i Certificate of Destruction: Med-Waste Systems, LLC certifies that the material listed above is treated in accordance with CODE AREA UN3291, Regulated Medical Waste, 2275 n.o.s., 6.2, PGII Ao arm... COMPANY NAME TELEPHONE NUMBER DVI-Deuel Vocational Institution (209) 835-4141 x 5513 ADDRESS p 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 W U.S. Department of Transportation. Imo,, ✓IA , 'V`�0"""'�t'z 04-29-2021 9:17 AM Mike Messer NAM E O F COM PANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE NAMES) OF PERSONS COLLECTING, TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER Evan Lieber EL 5039 COMPANY NAME TELEPHONE NUMBER w Med-Waste Systems, LLC (818) 998-5533 it ADDRESS DATE MEDICAL WASTE COLLECTED a 2261 Palma Dr Unit 5 Ventura, CA 93003 04-29-2021 9:17 AM Z Bio 38. gallon Pharm waste = or < 2 gallon eye Wk. o,e. e arc. s cant . a, 1 17 1 12 H 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 Of 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 04-29-20219:17 AM N AM E O F CO M PAN Y REPRESENTATIVE(Print) SIG N ATURE O F REPRESEN TATIVE DATE TRANSFER STATION: NAME REGISTRATION NUMBER NAME(S) OF PERSONS CO LLECTING, TRAIN SPO RTIN G O R UNLOADIN G WASTE INITIALS. REGISTRATION NUMBER N w K COMPANY NAME TELEPHONE NUMBER O a Z ADDRESS DATE MEDICAL WASTE COLLECTED ¢ poo� .e om. .e om. . �� a om. .« E- 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 v¢~i of falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. w N Z � NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE COMPANY NAME TELEPHONE NUMBER } E- U ADDRESS ¢ w PERM IT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED Z DISCREPANCY INDICATION SPACE K 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 2 requirements outlined in that authorization. F oc F- N AM E OF COM PANY REPRESENTATIVE(Print) SIG NATURE OF REPRESENTATIVE DATE In case of emergency, call ( 818 ) 998-5533 (24 -hr company or other emergency response group telephone) applicable local, state, and federal regulations.