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Regulated Medical Waste TRACKING DOCUMENTa 3031281 Certificate of Destruction: Med-Waste Systems, LLC certifies that the material listed above is treated 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 p 23500 Kasson Rd Tracy, CA 95376 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. � ^ Lex Maldonadoy V t..— 05-13-2021 9:32 AM NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE NAMES) OF PERSONS COLLECTING, TRANSPORTING ORUNLOADING WASTE INITIALS REGISTRATION NUMBER Evan Lieber EL 5039 COMPANY NAME TELEPHONE NUMBER QC Med-Waste Systems, LLC (818) 998-5533 W ¢ DATE MEDICAL WASTE COLLECTED ADDRESS a 2261 Palma Dr Unit 5 Ventura, CA 93003 05-13-2021 9:32 AM Z Pharm waste = or < 2 gallon Rio 38 gallon ont. a.a 00- e r nc : ons 2 7 4 69 F certify that the information provided above is Prue and correct and that only untreated 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. falsification a Evan Lieber 05-13-2021 9:32 AM N AM E OF CO M PANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE TRANSFER STATION: NAME REGISTRATION NUMBER NAME(S) OF PERSON S CO LLECTING, TRAN SPO RTIN G OR ON LOADING WASTE INITIALS REGISTRATION NUMBER N oc COMPANY NAME TELEPHONE NUMBER O ZADDRESS DATE MEDICAL WASTE COLLECTED K F Z icon �.s e< ons ont. wt.1 e<ont ort .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 W falsification ofthistracking document may result in forfeitureof mytransporter's registration and/orthe privilege of utilizing State -authorized facilities. Z z NAME OF COMPANY REPRESENTATIVE (Print) SIG NATURE OF REPRESENTATIVE DATE H COMPANYNAME TELEPHONE NUMBER H U ADDRESS Q w PERM IT NU M BER DATE WASTE WAS D EPOSITED/U N LO ADED TOTALWEIGHT DEPOSITED/UN LOADED Z DISCREPANCY INDICATION SPACE Q K H Z I certifythatl have been authorized to accept untreated medical wastes and thatl havereceived the aboveindicated wastes in accordancewith the Lu 2i requirements outlined in that authorization. F - Q I— NAME OF COMPANY REPRESENTATIVE(Print) SIGNATUREOF REPRESENTATIVE DATE In case of emergency, call ( 818 ) 998-5533 (24 -hr company or other emergency response group telephone) in accordance with applicable local, state, and federal regulations.