COMPLIANCE INFO_2015-2021 - Laserfiche WebLink

Home Browse Search

Regulated Medical Waste TRACKING DOCUMENT# 3228847 Certifi CODE AREA UN3291, Regulated Medical Waste, 2275 n.o.s., 6.2, PGII 7A. gy,..4ru 5%dArna" COMPANY NAME TELEPHONE NUMBER DVI-Deuel Vocational Institution (209) 835-4141 x 5513 ADDRESS O 23500 Kasson Rd Tracy, CA 95376 w 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. yJ Mike Messer 07-22-2021 9:57 AM NAM E O F COM PAN Y REPRESENTATIVE(P(inn SIGNATURE OF REPRESENTATIVE DATE NAMES) OF PERSON S COLLECTIN G. TRAN SPORTING O R UN LOADING WASTE INITIALS REGISTRATION NUMBER Evan Lieber EL 5039 COMPANYNAME TELEPHONE NUMBER w Med-Waste Systems, LLC (818) 998-5533 ¢ ADDRESS DATE MEDICAL WASTE COLLECTED O 2261 Palma Dr Unit 5 Ventura, CA 93003 07-22-20219:57 AM a u Z Bio 38 gallon can L ,Hs oar w oar .z m. a om. r wg 1 12 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 facilitles. < ::>/L a Evan Lieber 07-22-2021 9:57 AM NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE TRANSFERSTATION: NAME REGISTRATION NUMBER NAME(S) OF PERSONS COLLECTING, THAN SPO RTIN G OR UN LOADING WASTE INITIALS REGISTRATION NUMBER N ~4' COMPANY NAME TELEPHONE NUMBER O Q. Z Z ADDRESS DATE MEDICAL WASTE COLLECTED f— Z O � m �� .e u, .n o�� . .< .n o�,. .e s,a �� .r sr w 4 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 m falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. Z Q F NAME OF COMPANY REPRESENTATIVE(Print) SIGN ATURE OF REPRESENTATIVE DATE COMPANY NAME TELEPHONE NUMBER } F- Healthwise Services (559) 834-3333 U ADDRESS < 4800 E Lincoln Ave Fowler CA 93625 u. ¢ PERMIT NUM BER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED to TSOST-89 07-22-2021 1:30 PM 12.00 Z Q DISCREPANCY INDICATION SPACE F- H Z (certify that have been authorized to accept untreated medical wastes and that l have received the above indicated wastes in accordance with the g requirements outlined In that authorization. F - w Christian Rivera 07-22-2021 1:30 PM NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE GATE Incase of emergency, call (___81 8 ) 998-5533 (24 -hr company or other emergency response group telephone) cate of Destruction: Med-Waste Systems, LLC certifies that the material listed above is treated in accordance with applicable local, state, and federal regulations.