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Regulated Medical Waste TRACKINGDOCUMENT# 3309624 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 Idii��WASTE �� SYSTEMS n.o.s., 6.2, PGII COMPANY NAME TELEPHONE NUMBER DVI-Deuel Vocational Institution (209) 835-4141 x 5513 ADDRESS O 23500 Kasson Rd Tracy, CA 95376 F- ¢ 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. Lex Maldonado 08-19-2021 9:24 AM NAM E 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 F ¢ ADDRESS DATE MEDICAL WASTE COLLECTED 0 2261 Palma Dr Unit 5 Ventura, CA 93003 08-19-20219:24 AM a Z On 38 gallon ¢ �� oLnm. a one s v ni e � 0 0 y I certify that the information provided above 15 true and correct and that only untreated medical wastes are contained in [kis 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, ac _ L Evan Lieber 08-19-20219:24 AM NAME OF CO M PANY REPRESENTATIVE(Print) SIGNATURE O F REPRESENTATIVE DATE TRANSFER STATION: NAME REGISTRATION NUMBER N NAMES) O F PERSONS CO LLECTING, TRAN SPORTIN G OR UN LOADING WAS TE INITIALS I REGISTRATION NUMBER CC COMPANYNAME TELEPHONE NUMBER Owr- aZ K ADDRESS DATE MEDICAL WASTE COLLECTED F - Z O WLa F4 conLW.4 ons MA & cont #mnt Wt# F N 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 oc falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. QZ F- NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE COMPANYNAME TELEPHONE NUMBER y. F- Zi U ADDRESS ¢ PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED W Z D15CREPANCY 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 g requirements outlined in that authorization. F- oc t- N AM E O F 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)