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Regulated Medical Waste TRACKING DOCUMENT# 3011575 Certificate of Destruction: Med-Waste Systems, LLC certifies that the material listed above is treated in accordance with applicable local, state, and federal regulati CODE AREA UN3291, Regulated Medical Waste, qn.o.s., 2275 6.2, PGII v.q..s saw,,.. COMPANY NAME TELEPHONE NUMBER DVI-Deuel Vocational Institution (209) 635-4141 x 5513 ADDRESS O 23500 Kasson Rd Tracy, CA 95376 H 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. 1�1t � o�,�,, 05-06-2021 9:01 AM - `--`' Y" ' Mike Messer NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE NAME(S) OF PERSONS COLLECTING, TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER Evan Lieber EL 5039 COMPANY NAME TELEPHONE NUMBER on Med-Waste Systems, LLC (818)998-5533 F- DATE MEDICAL WASTE COLLECTED K ADDRESS a 2261 Palma Or Unit 5 Ventura, CA 93003 05-06-20219:01 AM z Bio 38 gallon Pharm waste = or < 2 gallon ran. a 0,,,. t .r Ec 2 25 1 2 F I certify that the information provided above Is true and correct and that only Untreated medical wastes are contained in this load.l am aware that y� falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. G C- 05-06-2021 9:01 AM a Evan Lieber NAM E O F CO M PAN Y REPRESENTATIVE(Print) SIG N ATTIRE D F REPR ESEN TATIVE DATE TRANSFER STATION: NAME REGISTRATION NUMBER NAMES) OF PERSONS COLLECTING, TRANSPORTING ORUNLOADING WASTE INITIALS REGISTRATION NUMBER N COMPANY NAME TELEPHONE NUMBER O Z DATE MEDICAL WASTE COLLECTED Q ADDRESS F 9ca m. %A.9 ww .ep 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 Lnii falsification of this tracking document may result in forfeiture of my transportees registration and/or the privilege of utilizing State -authorized facilities. CC Z Z N AM E O F C O M PANY REPRESEN TATIVE (Print) SIG N ATU RE OF REPRESEN TATIVE DATE COMPANYNAME TELEPHONE NUMBER } F- V ADDRESS Q ILL - PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED Lu Z DISCREPANCY INDICATION SPACE Q rz 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 UJ requirements outlined In that authorization. F- � NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE GATE In case of emergency, call ( 818 ) 998-5533 (24 -hr company or other emergency response group telephone) ons.