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Regulated Medical Waste. TRACKING DOCUMENT# 3070275 Certificate of Destruction: Med-Waste Systems, LLC certifies that CODEAREA 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 U.S. Department of Transportation. Lex Maldonado 05-27-2021 9:21 AM N AM E OF CO M PANY REPRESENTATIVE(Print) SIGNATURE O F REPRESENTATIVE DATE NAME(S) OF PERSONS COLLECTING, TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER Evan Lieber EL 5039 COMPANY NAME TELEPHONE NUMBER Med-Waste Systems, LLC (818) 998-5533 W ADDRESS DATE MEDICAL WASTE COLLECTED a 2261 Palma Dr Unit 5 Ventura, CA 93003 05-27-20219:21 AM Z BOD 38 gallon # one .a .a m, a ons .# ¢ 1 7 E y 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 a falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State- authorized facilities. Evan Lieber 05-27-20219:21 AM rl N AM E O F C O M PANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE TRANSFER STATION: NAME REGISTRATION NUMBER NAM PIS) OF PERSO N S CO LLECTING, TRANSPORTIN G OR ON LOADING WASTE INITIALS REGISTRATION NUMBER tV ¢ COMPANY NAME TELEPHONE NUMBER O Z ADDRESS DATE MEDICALWASTE COLLECTED Q C F Z O +oni.# Ts MA #oone ..a aoon� oonr# F- I certify that the information provided above is true and correct and that only untreated medical wastes are contained 1n 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. N aZ F NAM E OF CO M PANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE COMPANYNAME TELEPHONE NUMBER Y F— U ADDRESS Q w PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED Z 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 W requirements outlined in that authorization. H C 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) the material listed above Is treated in accordance with applicable local, state, and federal regulations.