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Feb, 25. 2016 11:50AM <br />No. 8337 af�P, 19/56 <br />Barnett Medical Ser - s, Inc 510-429^9913 Ph • <br />Date: <br />#: 70999 <br />' 3670 Enterprise Ave <br />t 5 Fax <br />Customer# 2560 <br />San Joaquin1(1-2.6-0 <br />Hayward Ca 94545Y <br />00040409nvironmental Health Department <br />r X°•_ n rlD#4891 P <br />DIRECTOR <br />LindANTw*g2U2Y;WQM0 <br />C t . 186> Eas��fiton Ave e <br />40 gal �� <br />, <br />r Care cente <br />Stiron, cegi 51RA?232 weekly <br />o <br />-PROGRAM COORDINATORS <br />Robert McClellon, REHS <br />r c�aG <br />8 gal <br />$455er Menth FLAT RkTE Jeff Carruesco, REHS, RDI Kasey Foley, REHS <br />gtiFo.R�;� Website: R�ti sjgov.org/ehci <br />Phone: (209) 468-3420 <br />Adrienne Ellsaesser, REHS <br />Rodney Estrada, REHS <br />aX: <br />Willy Ng, REHS <br />C1 Transfer Facility. DeAnation Focillty: O Altemale Transfer Facility O Altemete Destination Facility 13Dc+adeneon Facility <br />Danlels S►erpsrnart/BMS 13amott Medical Services,lno Danlele 8harpsmart Qirtis Bay Energy Photo waers Recyoling Inc <br />3070F"lerpdseAve 2985 Arch R[I#aOO 4144 r=_Them eaAva 3200 Hawsdns Point Rd 29BO Kerner Mwd*C <br />Hayward CA &4645 Storrjdon CJS 95215 Fresno CA 93725 tialomora MD 212.28 seri Rafael CA 04W1 <br />(510) 429-9911 (510) 4299911 55&4046252 (410) 354-3228 416) 459 Beo7 <br />Permit#TS109T--10fi Permit#TS/0ST-55 P.r d#2AD5-WMI-0036 ermftFRP1NR12276A <br />Date 4 fS <br />Wwte Collected: UN 3291 Regulated Medical Waste n.o.s. 6,7 -PG II <br />Weight Product <br />Shams Containers Reg laced MedPcal Waste Pharmaceutical Trane Chemotherapy <br />Size Qty: Size QXy: Wt Size Qty: Wt: Size' <br />Qty: Wt <br />Up to: 3 gal <br />Dental W e• <br />2 gal <br />'0 gal <br />8 gal <br />12 gal <br />4 gal <br />38 gal <br />9 gal <br />18 gal <br />6 gal <br />40 gal �� <br />12 gal <br />20 gal <br />8 gal <br />44 gal <br />18 gal <br />38 gal <br />12 gal <br />Weight <br />Size CIy <br />Weight Product <br />Weight: <br />Pathogen: <br />Item # <br />Dental W e• <br />Amalgam:5lze <br />Qty Fimr-size <br />city <br />Developer: Size <br />Qty <br />Lead:Slze Qt <br />O6er:S1ze <br />Qt_ <br />Other. TYge <br />Size <br />Qt <br />Description: Qt: <br />Notes: e3�add1 tub beyond (g) <br />Generator Certifrcation. I hereby certify that the c—nts of this consignmentare furiy and accurately described above by proper shipp�ing name <br />and are classified, packed, marke4 and labeled, and are in all aspects in proper condition for transport according to <br />applicable government reguladone. <br />Generator (CuswFner) <br />Route Driver <br />Certificate of Destruction <br />Incineration <br />Certiflcat o of Destruction <br />Autodaved <br />Received Tlme Feb,25 <br />dedma that this shipment of w ee of hazardous <br />n6 and/or appropriate stat s and legulation5. <br />dame of authorized person (print) <br />Name of authorized person (print) sign <br />Name of authorized person (print) <br />Brett Fspicha <br />Nama of eumoriaed person (print) Signature <br />2016 11:52AM No -1498 <br />by the U5 mdeaffederaI <br />V// 7/� <br />Date <br />04/15/2015 <br />Dote <br />