COMPLIANCE INFO_2015-2021 - Laserfiche WebLink

Home Browse Search

Regulated Medical Waste TRACKING DOCUMENT ft 3207773 Certificate of Destruction: Med-Waste Systems, LLC certifies that the material listed CODE AREA UN3291, Regulated Medical Waste, 2275 mcl.s., 6.2, PGII aV"n�%7 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, of Z packaged, labeled/placarded; and are in proper condition for transportation according to the applicable regulations of the U.S. Department of Transportation. Mike Messer-- 07-15-2021 9:19 AM NAM E O F COM PANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE NAMES) OF PERSON S COLLECTING, TRAN SPORTIN G O R UNLOADIN G WASTE INITIALS REGISTRATION NUMBER Evan Lieber EL 5039 COMPANY NAME TELEPHONE NUMBER of Med-Waste Systems, LLC (818) 998-5533 of ADDRESS DATE MEDICAL WASTE COLLECTED 0 2261 Palma Dr Unit 5 Ventura, CA 93003 07-15-20219:19 AM z Bio 38 gallon r0 .« onL .« om. ns .. ons .. 0 F y 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 falsification of this tracking document may result in forfeiture of my transporter'sregistration and/or the privilege of utilizing State -authorized facilities. � rl� Evan Lieber 07-15-2021 9:19 AM a NAME OF COMPANY REPRESENTATIVE (Print/ SIGNATURE OF REPRESENTATIVE DATE TRANSFER STATION: NAME REGISTRATION NUMBER NAME(S) OF PERSONS COLLECTIN G. TRANSPO RTIN G OR ON LOADIN G WASTE INITIALS REGISTRATION NUMBER 5 COMPANYNAME TELEPHONE NUMBER O a Z ADDRESS DATE MEDICAL WASTE COLLECTED Q X F- O 0 nnt .« nt « om. « n .« onr. A H NI 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 M falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. N az F NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE COMPANY NAMETELEPHONE NUMBER H Healthwise Services (559) 834-3333 U ADDRESS < 4800 E Lincoln Ave Fowler CA 93625 PERM IT NUM BER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED w TSOST-89 07-15-2021 12:49 PM Z Q DISCREPANCY INDICATION SPACE K 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 W requirements outlined in that authorization. H wChristian Rivera 07-15-2021 12:49 PM � 1' NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE In case of emergency,ca ll( 818 )998-5533 (24 -hr company or other emergency response group telephone) above is treated in accordance with applicable local, state, and federal regulations.