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Regulated Medical Waste oc', TRACKING DOCUMENT# 3186772 Certificate of Destruction: Med-Waste Systems, LLC certifies that the material listed above is treated In accordance with applicable local, state, and federal regulations. CODE AREA %7 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 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.5. Department of Transportation. � 07-08-2021 9:11 AM Mike Messer YN\(�`Y"V" V' N AM E O F COMPAN Y REPRESENTATIVE (Print) SIGNATURE O F REPRESENTATIVE DATE NAME(S) OF PERSON S CO LLECTIN G, TRAN SPO RTING O R UN LOADING WASTE INITIALS REGISTRATION NUMBER Evan Lieber EL 5039 COMPANY NAME TELEPHONE NUMBER ct Med-Waste Systems, LLC (818) 998-5533 w K ADDRESS DATE MEDICAL WASTE COLLECTED 0 2261 Palma Dr Unit 5 Ventura, CA 93003 07-08-20219:11 AM z Bio 38 gallon Pharm waste = or < 2 gallon cont. ,n.. om. . anL a nr. a oar .® 2 38 2 11 F > I certify that the Information provided above is true 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. Q L a Evan Lieber 07-08-2021 9:11 AM NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE TRANSFER STATION: NAME REGISTRATION NUMBER NAME(5) OF PERSON 5 CO LLECTING, TRAN SPORTIN G OR UNLOADIN G WASTE INITIALS REGISTRATION NUMBER N K COMPANY NAME TELEPHONE NUMBER O Z ADDRESS DATE MEDICALWASTE COLLECTED Q K F— Z OF- ,on, ae,nc .nomnt w�.r kcant, NI certify that the Information provided above is true and correct and that on ly untreated medical wastes are contained 1n this load.I 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. N Z NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE COMPANY NAME TELEPHONE NUMBER Healthwise Services (559) 834-3333 V ADDRESS LL 4800 E Lincoln Ave Fowler CA 93625 PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED uw- TSOST-89 07-08-2021 1:14 PM 49.00 Z Q DISCREPANCY INDICATION SPACE F- 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 requirements outlined in that authorization. ® C -/V`-' w Christian Rivera 07-08-2021 1:14 PM NAME OF COM PAN REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE In case of emergency, call( 818 ) 998-5533 (24 -hr company or other emergency response group telephone) Certificate of Destruction: Med-Waste Systems, LLC certifies that the material listed above is treated In accordance with applicable local, state, and federal regulations.