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FAM Regulated Medical Waste TRACKING OONMENTq 3289194 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 n.o.s., 6.2, PGII COMPANY NAME TELEPHONE NUMBER DVI-Deuel Vocational Institution (209) 835-4141 x 5513 ADDRESS p 23500 Kasson Rd Tracy, CA 95376 1— ¢ I certify that the information provided is true and correct, and that the generated materials are properly classified, described, rr Z packaged, labeled/placarded; and are in proper condition for transportation according to the applicable regulations of the U.S. Department of Transportation. Alvin Tabisula 4�r 08-12-2021 9:07 AM N AM E O F COMPANY REPRESENTATIVE(Print) SIGN ATURE OF REPRESENTATIVE DATE NAMES) OF PERSONS COLLECTING, IRAN SPO RTIN G OR ON LOADIN G WASTE INITIALS REGISTRATION NUMBER Evan Lieber EL 5039 COMPANY NAME TELEPHONE NUMBER w Med-Waste Systems, LLC (818) 998-5533 F_ t ADDRESS DATE MEDICAL WASTE COLLECTED O 2261 Palma Dr Unit 5 Ventura, CA 93003 08-12-2021 9:07 AM a Z Bio 38 gallon ¢M.0 N mnt MA gcpnt e F 0 0 > 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. �` d Evan Lieber ` 08-12-2021 9:07 AM N AM E O F CO M PAN Y REPRESENTATIVE(Print) SIG N ATU RE O F REPRESEN TATIVE DATE TRANSFER STATION: NAME REGISTRATION NUMBER NAME(S)OF PERSO N 5 CO LLECTING, TRAN SPO REIN G OR UN LOADING WASTE INITIALS REG15TRATION NUMBER tV �¢u ¢ COMPANYNAME TELEPHONENUMBER O Z Q ADDRESS DATE MEDICAL WASTE COLLECTED F- F— Z O sconL Ocont. 0 conL WLr 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 vQ~i c falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. LLZ F NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE COMPANY NAME TELEPHONE NUMBER Y F U ADDRESS Q PERMIT NUM BER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED Z ¢ DISCREPANCY INDICATION SPACE z r 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 W requirements outlined in that authorization. F- 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.