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Regulated Medical Waste TRACKING DOCUMENT# 3088098 Certificate of Destruction: Med-Waste Systems, LLC certifies that the CODE AREA UN3291, Regulated Medical Waste, 2275 n.o.s., 6.2, PGII Y7. aV5�4a4oft COMPANY NAME TELEPHONE NUMBER DVI-Deuel Vocational Institution (209) 835-4141 x 5513 ADDRESS p 23500 B asson 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. Spencer Osakeu �,,py/(�� scu" 06-03-2021 9:27 AM N AM E O F COM PANY 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 QC Med-Waste Systems, LLC (818) 998-5533 ¢ ADDRESS DATE MEDICALWASTE COLLECTED 2261 Palma Dr Unit 5 Ventura, CA 93003 06-03-2021 9:27 AM M Le o#c nnr. e F 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 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 06-03-2021 9:27 AM NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE TRANSFER STATION: NAME REGISTRATION NUMBER NAMES) OF PERSONS COLLECTING, TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER N ¢ COMPANYNAME TELEPHONE NUMBER O a ZADDRESS DATE MEDICAL WASTECOLLECTED 4 F Q ons onL s cont a m. s nc .a 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 falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State authorized facilities. Z F- NAME OF COMPANY REPRESENTATIVE(Print) SIG NALL flE OF REPRESENTATIVE DATE COMPANYNAME TELEPHONE NUMBER Y f- Healthwise Services (559) 834-3333 U ADDRESS < 4800 E Lincoln Ave Fowler CA 93625 w PERMIT NUMBER DATEWASTEWASDEP051TED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED TSOST-89 06-03-2021 12:33 PM Z Q DISCREPANCY INDICATION SPACE K E- 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. ~ w Christian Rivera / I 06-03-2021 12:33 PM 1 G� F 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) material listed above is treated in accordance with applicable local, state, and federal regulations.