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Regulated Medical Waste TRACKING DOCUMENT It 3228847 Certificate of Destruction: Med-Waste Systems, LLC certifies that the material listed above is CODE AREA UN3291, Regulated Medical Waste, 2275 n.o.s., 6.2, PGII 7A. aka^ %A svn COMPANY NAME TELEPHONE NUMBER DVI-Deuel Vocational Institution (209) 835-4141 x.5513 ADDRESS p 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 U.S. Department of Transportation. Mike Messer y �� 07-22-20219:57 AM N AM E O F COM PANY REPRESENTATIVE(Print) S16NATURE OF REPRESENTATIVE DATE N AM E(S) OF PERSONS COLLECTING, TRANSPORTING OR UN LOADING WASTE INITIALS REGISTRATION NUMBER Evan Lieber EL 5039 COMPANY NAME TELEPHONE NUMBER of Med-Waste Systems, LLC (818) 998-5533 K ADDRESS DATE MEDICAL WASTE COLLECTED 0 2261 Palma Dr Unit 5 Ventura, CA 93003 07-22-20219:57 AM a Z Bio 38 gallon oor.1 �e.r 0L a ooc . m. ant .. 12 N y 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 of falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. of Evan Lieber �L 07-22-20219:57 AM NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE TRANSFER STATION: NAME REGISTRATION NUMBER NAM List OF PERSON S CO LLECTIN G, TRAN SPORTIN G O R UNLOADIN G WASTE INITIALS REGISTRATION NUMBER N of s COMPANY NAME TELEPHONE NUMBER O DL Z ADDRESS DATE MEDICALWASTE COLLECTED F Z C)gCont 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 v¢~i W falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. z F- NAME OF COM PAN Y REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE COMPANY NAME TELEPHONE NUMBER Y F- U ADDRESS PERMIT NUM HER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED Z ¢ DISCREPANCY INDICATION SPACE K H Z. I certify that l have been authorized to accept untreated medical wastes and that l have received the above indicated wastes in accordance with the ul g requirements outlined In that authorization. F- to � 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) treated in accordance with applicable local, state, and federal regulations.