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Regulated Medical Waste TRACKING DOCUMENT# 3289194 Certificate of Destruction; Med-Waste Systems, LLC certifies that the material listed above is treated in accordance CODE AREA %n.o.s., UN3291, Regulated Medical Waste,22'5 6.2, PGII W14.4444444 SoGsw" COMPANY NAME TELEPHONE NUMBER DVI-Deuel Vocational Institution (209) 835-4141 x 5513 ADDRESS p 23500 Kasson Rd Tracy, CA 95376 h 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. Alvin Tabisula 08-12-2021 9:07 AM N AME O F COM PANY 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 w Med-Waste Systems, LLC (818) 998-5533 ¢ ADDRESS DATE MEDICAL WASTECOLLECTED a 2261 Palma Dr Unit 5 Ventura, CA 93003 08-12-20219:07 AM Z Bio 38 gallon cont. aJ0 am w aaL r „c .w ni r 0 H y I certify that the information provided above is true and correct and that only untreated medical wastes are containedin this load. I am aware that a falsification of this tracking document may result In forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. i Evan Lieber 08-12-20219:07 AM N AM E O F COM PAN Y REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE TRANSFER STATION: NAME REGISTRATION NUMBER NAME(S) OF PERSON 5 COLLECTING, THAN SPORTIN G O R UN LOADIN G WASTE INITIALS REGISTRATION NUMBER ry w it COMPANY NAME TELEPHONE NUMBER O a Z Q ADDRESS DATE MEDICAL WASTE COLLECTED K H Z c .. oar , oar , cant. , ons , I certify that the Information provided above Is true and correct and that only untreated medical wastes are contained in this load. lam aware that v¢~i falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. Zz E- NAME OF COMPANY REPRESENTATIVE(Print) SIG NATURE OF REPRESENTATIVE DATE COMPANY NAME TELEPHONE NUMBER Y Healthwise Services (559) 834-3333 V ADDRESS w 4800 E Lincoln Ave Fowler CA 93625 PERMIT NUMBER DATEWASTEWAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED TSOST-89 08-12-2021 12:37 PM Z Q 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 grequirements outlined in that authorization. H w Cruz Lopez 08-12-2021 12:37 PM of I-- NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE In case of emergency, call ( 816 ) 998-5533 (24 -hr company or other emergency response group telephone) With applicable local, state, and federal regulations.