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Regulated Medical Waste TRACKING DOCUMENT# 3168682 Certificate of Destruction: Med-Waste Systems, LLC certifies that the CODE AREA UN3291, Regulated Medical Waste, 2275 n.o.s., 6.2, PGII COMPANY NAMETELEPHONE NUMBER DVI-Deuel Vocational Institution (209) 835-4141 x 5513 ADDRESS p 23500 Kasson Rd Tracy, CA 95376 a I certify that the information provided is true and correct, and that the generated materials are properly classified, described, packaged, labeled/placarded; and are in proper condition for transportation according to the applicable regulations of the Z U.S. Department of Transportation. � Q � � Mike Margullis G/` 07-01-2021 8:58 AM N AME OF CO M PANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE NAME(S) OF PERSONS COLLECTIN G, TRAN SPO RTIN G O R ON LOADING WASTE INITIALS REGISTRATION NUMBER Evan Lieber EL 5039 COMPANY NAME TELEPHONE NUMBER w Med-Waste Systems, LLC (818) 998-5533 K ADDRESS DATE MEDICAL WASTE COLLECTED 0 2261 Palma Dr Unit 5 Ventura, CA 93003 07-01-20218:58 AM Z Z om. 0 > 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. L a Evan Lieber C 07-01-20218:58 AM NAME OF CO M PAN Y REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE TRANSFERSTATION: NAME REGISTRATION NUMBER NAME(S) OF PERSO N S CO LLECTIN G, TRAN SPORTIN G OR ON LOADIN G WASTE INITIALS REGISTRATION NUMBER N W Evan Lieber EL it COMPANYNAME TELEPHONE NUMBER 0- (Stockton) Med-Waste Systems, LLC (818) 998-5533 4ADDRESS DATE MEDICAL WASTE COLLECTED F- 4079 Cherokee Rd Stockton CA 95215 07-01-2021 10:31 AM Z �„ r e�� .r 9 COAL WtA I ront. Wt.9 am. e 0 0 NI certify that the information provided above Is true and correct and that only untreated medical wastes are contained In this load. 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. Z Evan Lieber 07-01-2021 10:31 AM NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE COMPANY NAME TELEPHONE NUMBER I}_— Healthwise Services (559) 834-3333 U ADDRESS < 4800 E Lincoln Ave Fowler CA 93625 w PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED TSOST-89 07-06-2021 12:54 PM Z DISCREPANCY INDICATION SPACE Q 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 W requirements outlined in that authorization. E- /T < w Christian rivera /lJlt�//r� 07-06-2021 12:54 PM or F- NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE Incase 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.