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Regulated Medical Waste 11111k ftl MANIFEST® 3184268 1W CODE AREA BARNm M)DtcALSmvfcFs,INc UN3291, Regulated Medical Waste, e4r& r,-sa64n t*#O. Aftw n.o.s., 6.2, PGII COMPANY NAME TELEPHONE NUMBER In 2 Skin Tattoo (209) 464-9774 x Jose ADDRESS 0 2738 Pacific Ave Stockton, CA 95204 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. L7 Jose ///if� 07-07-2021 1:07 PM NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE Of REPRESENTATIVE DATE NAME(S)OF PERSONS COLLECTING, TRAN SPORTIN G OR UNLOADING WASTE INITIALS REGISTRATION NUMBER Marry Montez MM 6183 COMPANY NAME TELEPHONENUMBER w Barnett Medical Services (800) 748-1803 ADDRESS DATE MEDICALWASTE COLLECTED a P.O. Box 4436 Hayward, CA 94540 07-07-2021 1:07 PM Z 20 Gal RMW an,. .• .L .. enc z1 16 F > I certify that the information provided above is true and correct and that only untreated medical wastes are contained in this load.l am aware that falsification of this manifest may result in forfeiture of my transporters registration and/or the of utilizing State -authorized facilities. °C Marty Montez 07-07-2021 1:07 PM a NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE TRANSFER STATION: NAME REGISTRATION NUMBER NAM Fist OF PERSONS CO LLECTING, TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER N w OCOMPANY NAME TELEPHONE NUMBER o_ QZ ADDRESS DATE MEDICALWASTE COLLECTED F Z O e„c.a onc . eye. ..c• nr. .• sm,rt. HN 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 manifest may result in forfeiture of my transporters registration and/or the privilege of utilizing State -authorized facilities. LL Z ¢Z F NAM E O F COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE COMPANYNAME TELEPHONENUMBER ADDRESS r f � PERMIT NUMBER DATE WASTE WAS DEPOSRED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED U Q LL F- DISCREPANCY INDICATION SPACE Z F— w I certify that l have been authorized to accept untreated medical wastes and that l have received the above indicated wastes in accordance with the F requirements outlined in that authorization. NAME OF COMPANY REPRESENTATIVE (Print) SIGNATURE OF REPRESENTATIVE DATE In case of emergency, call ( 925 1 321-5938 (24 -hr company or other emergency response group telephone)