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Feb.25.2016 11:51AM <br />Barnett Medical Se s, Inc <br />3670 E=nterprise Ave <br />Hayward Ca 94545 <br />EPAOCAL000404096 <br />Transporter ID#489i <br />�`nerator: <br />wine Countriv Care Center - Lodi <br />311 West Turner Road <br />Lodi, CA 96240 <br />510-429-9911 Ph <br />510266-0945 Fax <br />Contact- Pat <br />No, 8337 P. 24/56 <br />Date: tcre-u +;? <br />Manifest <br />Customer#- 2560 <br />Worc (209) 334-37060 <br />Frequency of Service Weemy <br />Pricing 65 per Month FLAT --.QA ­rE <br />O Transfer Facility: <br />0 Deetlnatlon Facility_ <br />0 Attornato Transfer Facility 0 Alternate Dasilnation Facility <br />0 DLOstlon Facility <br />Dsnlels SherpsrrmarttBMS <br />Barnett Madiaal Servlces,inc <br />Daniels Sharperndn <br />Curtis Bay Enargy ' <br />Photo Waste Raeyaling Inc <br />3670 Enterprise Ave <br />2385 AMM Rd 16200 <br />4144 E. Therese Ave <br />3200 Hawkins Point Rd <br />2980 Kerner Slvd rrC <br />Hayward CA 94545 <br />Stockton CA 95210 <br />Fresno CA 9372S <br />Battlmnre MD 21220 <br />a n Rafete1 CA 94901 <br />(610) 429-9911 <br />(610) 429-9911 <br />669.634-6252 <br />(410) 394.3228 <br />(469-B60T <br />perm8ls'T�OSr1oa _ <br />Permll#TS/OST-65 <br />Pertni1A2009•WMI-0036 <br />petit PWR 122704 <br />Date <br />Waste Collected: UN 3291 Regulated Medical Waste rf.o,s. 6.2 pd II <br />Sharps Containers <br />- eutated Medical Waste <br />pharmaceutical <br />Tr thera <br />Size Qty, <br />Size Qty: Wt <br />Size Qty: <br />Wt: Size Qty; <br />Wt <br />Up to. <br />3 gal <br />2 gal <br />20 gat <br />a gal <br />12 gal <br />4 gal <br />38 gal <br />9 gal <br />18 gal <br />6 gal <br />40 gel .�12 <br />gal <br />20 gal <br />S gal �w <br />44 gal <br />18 gal <br />38 gal <br />12 gal <br />Weight <br />/—'jai <br />Size Qty <br />Weight <br />Product De "Lygr�d: <br />tidcight: <br />PdhQual <br />Item# Description-. <br />Qt: <br />Arnalgarn:Size-Qty-Fixer SizeQty, <br />LeedtSize Qt Other.Slz2 Qty <br />Other: Type Size <br />NOteS:ea .add[ tuts beyond (0) <br />Deve loper:size Qty <br />r <br />Generator Certification: I hereby certify that the contentsoft hird Cansignmant are fully and accuretolydescribed above by proper ship pIng narne <br />slid aro r[ossified, packed, marked, and labeled, and are in all aspects in proper condltton for transport according to <br />applitabl6 government regulations. <br />I further declare that this shipment of waste is tree of hazardous and merwrvvraste as defined by the US codeof federal <br />regulations and/or appropriate state rule and regulations, <br />.Generator (Customer) 'l <br />N me Ofaut arized person priht) Signatur Dat <br />Raute Driver 1 <br />Name of Quthorized person (print) Signature ate <br />e:erdficate of Destruction <br />Inclneratio n Name of authorized person (print) Sjgn ur Date <br />Brett Espicha '. 05/20/2015 <br />Certificate of Destruction <br />Qutodaved Name of duthorized person (print) Signature Data <br />Received Time Feb.25.'2016 11:52AM No.1498 <br />