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Regulated Medical Waste 2275 V45m�*00 n.o.s., 6.2, PGII TRACKING DOCUMENT I{ 3248529 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 UN3291, Regulated Medical Waste, 2275 V45m�*00 n.o.s., 6.2, PGII 744 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 W packaged, labeled/placarded; and are in proper condition for transportation according to the applicable regulations of the U.S. Department of Transportation. Mike Messer 07-29-2021 9:22 AM NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE NAME(S)OF PERSONS COLLECTING* TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER Evan Lieber EL 5039 COMPANY NAME TELEPHONE NUMBER of Med-Waste Systems, LLC (818) 998-5533 ¢ ADDRESS. DATE MEDICAL WASTE COLLECTED 2261 Palma Dr Unit 5 Ventura, CA 93003 07-29-2021 9:22 AM a tZI Z Bio 38 gallon Pharm waste = or c 2 gallon Chemo waste nL e.. nr. .a Jta)nt .r nL a nn. A 4 75 9 20 2 2 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 falsification of this tracking document may result in forfeiture of my transpor ees registration and/or the privilege of utilizing State -authorized facilities. a Evan Lieber 07-29-20219:22 AM NAMEOF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE TflANSFER STATION: NAME REGISTRATION NUMBER NAME(S) OF PERSON S COLLECTIN G, TRANSPORTIN G OR UNLOADING WASTE INITIALS REGISTRATION NUMBER N C COMPANY NAME TELEPHONE NUMBER O a Z Q ADDRESS DATE MEDICAL WASTE COLLECTED 5 F - Z O wt's 4 cont- wt. a 0 cont, MA F I 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 vQ~i ¢ falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. z of NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE COMPANY NAME TELEPHONE NUMBER Y I_- Flealthwise Services (559) 834-3333 U ADDRESS LL 4800 E Lincoln Ave Fowler CA 93625 w PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED TSOST-89 07-29-2021 12:39 PM 97.00 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. F �q W Christian RiverayK 07-29-202112:39 PM 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) Certificate of Destruction: Med-Waste Systems, LLC certifies that the material listed above is treated In accordance with applicable local, state, and federal regulations: