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Regulated Medical Waste TRACKING DOCUMENT# 3268550 Certificate of Destruction: Med-Waste Systems, LLC certifies that the CODE AREA UN3291, Regulated Medical Waste, 2275 V4qWra^5%4�"^ n.o.s., 6.2, PGII 7A COMPANY NAME TELEPHONE NUMBER DVI-Deuel Vocational Institution (209) 835-4141 x 5513 ADDRESS p 23500 Kasson Rd Tracy, CA 95376 F certify that the information provided is true and correct, and that the generated materials are properly classified, described, u' packaged, labeled/placarded; and are in proper condition for transportation according to the applicable regulations of the Z U.S. Department of Transportation, l7 Mike Messer 08-05-20219:10 AM NAME O F CO M PAN Y REPRESENTATIVE(Print) SIG N ATURE O F REPRESENTATIVE DATE NAMES) OF PER50NS COLLECTIN G, TRANSPORTIN G O R UN LOADING WASTE INITIALS REGISTRATION NUMBER Evan Lieber EL 5039 COMPANY NAME TELEPHONE NUMBER Cc Med-Waste Systems, LLC (818) 998-5533 of ADDRESS DATE MEDICAL WASTE COLLECTED 0 2261 Palma Dr Unit 5 Ventura, CA 93003 08-05-20219:10 AM Z Boo 38 gallon rr 00,. ., oo,. r n,. r oo,. .. 0 0 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 falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. � C II AM a Evan Lieber 1-. 08-05-2021 9:10 NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE TRANSFERSTATION: NAME REGISTRATION NUMBER NAM Fist OF PERSO N S CO ELECTING, TRAN SPORTING O R UNLOADIN G WASTE INITIALS REGISTRATION NUMBER N ¢ COMPANY NAME TELEPHONE NUMBER O Z Q ADDRESS DATE MEDICAL WASTE COLLECTED F Z O #conc MA 0 cont. r lconL MA 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 cc falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. z a H NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE COMPANY NAME TELEPHONE NUMBER r 1_ Healthwise Services (559) 834-3333 U ADDRESS < 4800 E Lincoln Ave Fowler CA 93625 PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED W TSOST-89 08-05-2021 12:56 PM Z Z DISCREPANCY INDICATION SPACE F- F Z (certify that) have been authorized to accept untreated medical wastes and that have received the above indicated wastes in accordance with the W g requirements outlined In that authorization. W Rafael Carrillo �c 08-05-2021 12:56 PM r � NAME OF COM PANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE In case of emergency, call( 818 ) 998-5533 (24 -hr company or other emergency response group telephone) material listed above Is treated in accordance with applicable local, state, and federal regulations.