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Regulated Medical Waste TRACKING DOCUMENT# 3207773 j'f Cert CODE AREA 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 0 23500 Kasson Rd Tracy, CA 95376 H � 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 w U.S. Department of Transportation. Mike Messer 07-15-2021 9:19 AM NAME OF COM PANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE NAME(5) OF PERSON S COLLECTING, TRAN SPO RTING O R UN LOADIN G WASTE INITIALS REGISTRATION NUMBER Evan Lieber EL 5039 COMPANY NAME TELEPHONE NUMBER w Med-Waste Systems, LLC (818) 998-5533 ¢ ADDRESS DATE MEDICAL WASTE COLLECTED 2261 Palma Dr Unit 5 Ventura, CA 93003 07-15-2021 9:19 AM Q0. Z Bio 38 gallon r .a o�c w ani. . �c a mt. A 0 0 F > 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. Of C� L Evan Lieber 07-15-2021 9:19 AM rl N AM E O F C O M PAN Y REPRE5 EN TATIVE(Print) SIG N ATU RE O F REPRESEN TATIVE DATE TRANSFER STATION: NAME REGISTRATION NUMBER NAMES) O F PERSON S CO LLECTIN G, TRAN SPORTING O R UN LOADING WASTE INITIALS REGISTRATION NUMBER N COMPANY NAME TELEPHONE NUMBER O Z ADDRESS DATE MEDICAL WASTE COLLECTED F Z w„r o�ne wr a<ani econr ,on[ ap 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. w Z Q H NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE COMPANYNAME TELEPHONE NUMBER } H V ADDRESS ¢ PERM IT NUM BER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL W EIGHT DEPOSITED/UNLOADED w Lo Z DISCREPANCY INDICATION SPACE K f- H Z (certify that/ have been authorized to accept untreated medical wastes and that/ have received above indicated wastes in accordance with the grequirements outlined In that authorization. F of 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) ificate of Destruction: Med-Waste Systems, LLC certifies that the material listed above is treated in accordance with applicable local, state, and federal regulations.