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Regulated Medical Waste TRACKINGDOCUMENTN 3070275 Certificate of Destruction: Med-Waste Systems, LLC certifies that the CODE AREA UN3291, Regulated Medical Waste, qmcl,s., 2275 6.2, PGII no WI �4 ra COMPANY NAME TELEPHONE NUMBER DVI-Deuel Vocational Institution (209) 835-4141 x 5513 ADDRESS O 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 COM PANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE NAME(S) OF PERSON S COLLECTIN G. TRAN SPORTIN G OR UN LOADING WASTE INITIALS REGISTRATION NUMBER Evan Lieber EL 5039 COMPANY NAME TELEPHONE NUMBER Med-Waste Systems, LLC (818) 998-5533 W F- ADDRESS DATE MEDICAL WASTE COLLECTED a 2261 Palma Dr Unit 5 Ventura, CA 93003 05-27-20219:21 AM Z Bio 38 gallon c e , onc WLj H y I certify that the information provided above is [rue and correct and that only untreated medical wastes are contained In this load./ am aware that Cc falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. 4 a Evan Lieber 05-27-2021 9:21 AM NAME OF COMPANY REPRESENTATIVE (Print) SIG N ATU RE O F REPRESENTATIVE DATE TRANSFER STATION: NAME REGISTRATION NUMBER NAME(S) OF PERSON S COLLECTIN G. TRAN SPORTIN G OR UNLOADING WASTE INITIALS REGISTRATION NUMBER N z COMPANY NAME TELEPHONE NUMBER O Q. Z ADDRESS DATE MEDICAL WASTE COLLECTED F O9 conL. A 4 om. WL9 4 cort. MA I cont MA H 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 Lo ¢ falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State- authorized facilities. Z z NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE H COMPANY NAME TELEPHONE NUMBER } F- Flealthwise Services (559) 834-3333 V ADDRESS < 4800 E Lincoln Ave Fowler CA 93625 PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED TSOST-89 05-27-2021 12:46 PM 7.00 Z DISCREPANCY INDICATION SPACE Q s H 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. E- j < Javier Regis `/ U, lri 05-27-2021 12:46 PM r � NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE In of emergency, call ( 818 ) 998-5533 (24 -hr company or other emergency response group telephone) material listed above is treated in accordance with applicable local, state, and federal regulations.