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Regulated Medical Waste TRACKINGDOCUMENT# 3330179 Certificate of Destruction: Med-Waste Systems, LLC certifies that the material listed above is treated in accordance CODE AREA � UN3291, Regulated Medical Waste, 2275 It412WAST€ �� 5"SEMS 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 I certify that the information provided is true and correct, and that the generated materials are properly classified, described, � packaged, labeled/placarded; and are in proper condition for transportation according to the applicable regulations of the Z U.S. Department of Transportation. Lex Maldonado 08-26-20219:13 AM NAM E OF CO M PANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE N AM EIS) OF PERSONS COLLECTING, THAN SPO RTING OR ON LOADING WASTE INITIALS REGISTRATION NUMBER Evan Lieber EL 5039 COMPANY NAME TELEPHONE NUMBER W Med-Waste Systems, LLC (818) 998-5533 iM ADDRESS DATE MEDICAL WASTE COLLECTED O 2261 Palma Dr Unit 5 Ventura, CA 93003 08-26-2021 9:13 AM a Z eio 38 gallon Pharm waste 32 gal reusabl ¢� o„i i., 00�. ., 00. , ni .. o„r , 2 42 1 60 > I certify that the information provided above Is true and correct and that only untreated medical wastes are contained In this load./ am aware that 4 falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. �L W Evan Lieber 08-26-20219:13 AM NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE TRANSFERSTATION: NAME REGISTRATION NUMBER NAM E(S) OF PERSON S CO LLECTING, TRAN SPORTIN G OR UN LOADIN G WASTE INITIALS REGISTRATION NUMBER N u�l K COMPANY NAME TELEPHONE NUMBER O N Z ADDRESS DATE MEDICAL WASTE COLLECTED ocF- F- Z O$cant. aoocWL9 scant Wt.1 a tent. WL , ttont a F I certify that the information provided above is true and correct and that only untreated medical wastes are contained in this load./ am awarethat va~i ¢ falsification ofthistracking document may result In forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. Z Q F NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE COMPANY NAME TELEPHONE NUMBER } H U ADDRESS Q PERMIT NUMBER DATE WASTEWAS DEPOSITED/UNLOADED TOTALWEIGHT DEPOSITED/UNLOADED w Z Q DISCREPANCY INDICATION SPACE z F- F_ - ZF 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- Q oc I- 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) with applicable local, state, and federal regulations,