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Regulated Medical Waste TRAGKINGDOCUMENT# 3350689 Certificate of Destruction: Med-Waste Systems, LLC certifies that the CODEAREA UN3291, Regulated Medical Waste, 2275 MOM WASTE SYSTEMS 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 F � 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. L- McGhee `- ' ` — 09-02-2021 9:39 AM NAME O F COM PANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE NAME(S) OF PERSON 5 COLLECTIN G, TRAN SPO FLING OR ON LOADING WASTE INITIALS REGISTRATION NUMBER Evan Lieber EL 5039 COMPANY NAME TELEPHONE NUMBER w Med-Waste Systems, LLC (818) 998-5533 0c ADDRESS DATE MEDICAL WASTE COLLECTED a 2261 Palma Dr Unit 5 Ventura, CA 93003 09-02-20219:39 AM Z No 38 gallon ocon ,. w.e om. .. om. .eom ¢ 1 4 H 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 falsification of this tracking document may result in forfeiture of my transporter's registration and/or the privilege of utilizing State -authorized facilities. a Evan Lieber _ 09-02-2021 9:39 AM NAM E OF COM PAN Y REPRESENTATIVE(Print) SIG NATURE OF REPRESENTATIVE DATE TRANSFER STATION: NAME REGISTRATIONNUMBER NAM E(S) OF PERSON 5 CO LLECTING, TRAN SPO RTING OR ON LOADIN G WASTE INITIALS REGISTRATION NUMBER N Lu C COMPANY NAME TELEPHONE NUMBER O Q.n Z ADDRESS DATE MEDICAL WASTE COLLECTED CC Z Or icont econe eooi. Vn ecom. .« 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 transporters registration and/or the privilege of utilizing State -authorized facilities. Z NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE COMPANYNAME TELEPHONE NUMBER } 1_- Healthwise Services (559) 834-3333 U ADDRESS < 4800 E Lincoln Ave Fowler CA 93625 PERMIT NUMBER DATEWASTEWAS DEPOSIT ED/UNLOADEDTOTAL WEIGHT DEPOSITED/UNLOADED LL TSOST-89 09-02-2021 12:53 PM 4.00 Z DISCREPANCY INDICATION SPACE K 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 W 2 requirements outlined in that authorization. F W Javier Regis ✓" 09-02-2021 12:53 PM � 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) material listed above is treated in accordance with applicable local, state, and federal regulations.