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Regulated Medical Waste TRACKINGDOCUMENT# 3330179 Cert CODE AREA � WASTE 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 H 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 08-26-2021 9:13 AM NAM E O F CO M PAN Y REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE NAME(S) OF PERSONS COLLECTING, TRANSPORTING OR UNLOADING WASTE INITIALS REGI5TRATION NUMBER Evan Lieber EL 5039 COMPANY NAME TELEPHONE NUMBER X Med-Waste Systems, LLC (818) 998-5533 G: ADDRESS DATE MEDICAL WASTE COLLECTED 06 2261 Palma Dr Unit 5 Ventura, CA 93003 08-26-20219:13 AM z Bio 38 gallon Pharm waste 32 gal reusabl ter. e cont, WA nt .a nr w wnn� 2 42 1 60 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 G falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. CL a Evan Lieber 08-26-2021 9:13 AM NAMEOFCOMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE TRANSFERSTATION: NAME REGISTRATION NUMBER ry NAME(S) OF PERSONS COLLECTIN G, TRAIN 5PO RTING OR UN LOADING WASTE INITIALS REGISTRATION NUMBER COMPANY NAME TELEPHONE NUMBER O in Z Q ADDRESS DATE MEDICAL WASTE COLLECTED Z cnnt. .s F0 cunt R cent, .e 9 cont Q0 tj 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 W falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. Z Q H NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE COMPANYNAME TELEPHONE NUMBER Y f- Healthwise Services (559) 834-3333 U ADDRESS w 4800 E Lincoln Ave Fowler CA 93625 w PERM IT NUM BER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED TSOST-89 OS -26-2021 1:05 PM 102.00 Z Q DISCREPANCY INDICATION SPACE K H H 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 - w Javier Regis 08-26-2021 1:05 PM o: NAM 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) ificate of Destruction: Med-Waste Systems, LLC certifies that the material listed above is treated in accordance with applicable local, state, and federal regulations,