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A Regulated Medical Waste TRACNINGOOCUMENTn 3108657 Certificate of Destruction: Med-Waste Systems, LLC certifies that CODE AREA 7 UN3291, Regulated Medical Waste, 2275 T464ew. 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. s"'""" L'7 06-10-2021 9:02 AM Spencer Osakeu I �7`-I N AM E O F COM PANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE NAMES) OF PERSON S COLLECTING, THAN SPO RTIN G OR ON LOADING WASTE INITIALS REGISTRATION NUMBER Evan Lieber EL 5039 COMPANY NAME TELEPHONE NUMBER M Med-Waste Systems, LLC (818) 998-5533 ¢ ADDRESS DATE MEDICAL WASTE COLLECTED a 2261 Palma Dr Unit 5 Ventura, CA 93003 06-10-2021 9:02 AM Z Pharm waste = or < 2 gallon Bio 38 gallon on,. e wa r 0nL , of 6 34 1 26 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 CC 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 06-10-2021 9:02 AM a NAME OF COM PAN REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATNE DATE TRANSFER STATION: NAME REGISTRATION NUMBER NAMES) OF PERSONS COLLECTING, TRAN SPORTIN G OR UNLOADING WASTE INITIALS REGISTRATION NUMBER N ¢ COMPANYNAME TELEPHONE NUMBER O a Z ADDRESS DATE MEDICAL WASTE COLLECTED Q K H O WL+ WLr I wnt+ F- NI 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 w falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. ZZ N AM E O F CO M PAN Y REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE COMPANY NAMETELEPHONE NUMBER Healthwise Services (559) 834-3333 l.) ADDRESS < 4800 E Lincoln Ave Fowler CA 93625 PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED LL TSOST-89 06-10-2021 12:30 PM 60.00 ✓t Z DISCREPANCY INDICATION SPACE czcz F H 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 2irequirements outlined in that authorization. w Carlos Gomez c,., t 06-10-2021 12:30 PM � 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.