COMPLIANCE INFO_2015-2021 - Laserfiche WebLink

Home Browse Search

Regulated Medical Waste TRACKINGDOCUMENTN 3268550 Certificate of Destruction: Med-Waste Systems, LLC certifies thatthe material listed above is treated in accordance with applicable local, state, and federal regulations. CODE AREA UN3291, Regulated Medical Waste, 2275 n.o.s., 6.2, PGII 74.. Q(Je.A.lb SeG.to.. 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, 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 &5i 08-05-2021 9:10 AM N AME OF CO M PAN Y 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 Med-Waste Systems, LLC (818) 998-5533 w 0: ADDRESS DATE MEDICAL WASTE COLLECTED a 2261 Palma Dr Unit 5 Ventura, CA 93003 08-05-2021 9:10 AM Z Bio 38 gallon on e one .e nnc r nc .a nnc , 0 0 t I certify that the information provided above is [rue and correct and that only untreated medical wastes are contained in this load. I am aware that Q falsification of this tracking document may result in forfeiture of my transporter's registration and/orthe privilege of utilizing State -authorized facilities, � Evan Lieber I L 08-05-2021 9:10 AM a NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE TRANffERSTATION: NAME REGISTRATION NUMBER NAME(S) OF PERSO NS CO LLECTIN G, TRAIN SPORTIN G OR ON LOADING WASTE INITIALS REGISTRATION NUMBER rV C W it COMPANY NAME TELEPHONE NUMBER O Z Q ADDRESS DATE MEDICAL WASTE COLLECTED K F - Z O scontIa ons A #Cont WLI Ocont. .e Cont. MA F 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 falsification of this tracking document may result In forfeiture of mytransporter's registration and/or the privilege of utilizing Stateauthorizedfacilities. Z Z Q � NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE COMPANYNAME TELEPHONE NUMBER } F - j ADDRESS Q w PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIG HE DEPOSITED/UNLOADED Z Q DISCREPANCY INDICATION SPACE K H Z I certify that) have been authorized to accept untreated medical wastes and that I have received the above indicated wastes In accordance with the �j requirements outlined in that authorization. F - Q 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 thatthe material listed above is treated in accordance with applicable local, state, and federal regulations.