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Feb. 25, 2016 11:51AM <br />Harnett Medical Se s, Inc <br />a 3670 >✓nterprlse Ave <br />mw <br />Hayward Ca 94545 <br />EPA#cA1000494086 <br />Transporter 10#4891 <br />/'-�'ieretor: <br />Wane Ct>'untry Cgre Center Lodi <br />321 West Tumor RDad <br />Lodi. CA 96240 <br />Contact: Fat <br />No.8337 P. 25/56 <br />Date; fly/ieizu'l* <br />Manifest #: 781151 <br />Customer# 2560 <br />Frequency of Service vvel:kiy <br />Pricing $4165 per Moral FIAT RAT E <br />yvorx: M-? 9) ZZ14•3750 <br />OTransferFacility: <br />M DagOnatlon Paolllly: <br />IZ.ArternateTransrerFacility <br />O Alternate Destination Foolllty <br />O Deatlna0an racllity• <br />Daniela SharpsmarUBMS <br />blemed Medical Seivices,ino <br />Danlala Sharpamart <br />Curtis Bey Energy <br />Photo Waste Roayarrng Ino <br />3670 EnterprlseAve <br />2986 Arch Rd 4200 <br />4144 E, Therese Ave <br />2200 Hawkins Point Rd <br />2980 Kemer Blvd*C - <br />Hayward CA94546 <br />Stockton CA 95215 <br />Finano CA 93729 <br />9alllmore MD 21228 <br />San Rafael CA 94901 <br />(510)4295911 <br />(61 D) 420-8811 <br />558.834-6252 <br />(410) 854.9226 <br />(416) 469-8907 <br />9 gal <br />Permll0TWOST106 <br />Permh4T$1OeT-55 <br />permll#2005-WM1-0036 <br />Pormlt0PWR122704 <br />Date—" <br />-13a 6U/� <br />8 gal^ <br />44 gal <br />Waste Collected: UN 3291 Regulated Medical Waste n.o.s. 6.2 PC 'll <br />Sharps Containers <br />Regulated Medical ftstQ <br />Pharmaceutical <br />Trate Chernothetapy <br />Size Qty; <br />Size Qty: Wt <br />Size Qty: Wt; <br />Size <br />Qty: Wt <br />Up to: <br />3 gal <br />2 gal <br />20 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 Qty Weight <br />ProductDellyered: <br />Weight: <br />Pathogen: <br />Item# <br />Description: Qt: <br />eneel w Ate, <br />Amalgam: Size Qty Fixer: Size Qty, <br />Lead: Size Qt other.Slze Qt <br />Other: Type Size <br />Notes: uP G <br />ea acddi tub bayo iL (`) <br />Generator Certification: <br />Generator (Custom d <br />Route Driver <br />celydflcate of Destruction <br />I nci ne-ratio n <br />Developer. Size Qty <br />1 hereby certify that the contents ofthia consignment are fully and aocuratetydescribed above -by proper shtpping name <br />and are cla5si red, packed, marked, and labeled, and are In all aspects In proper condition for transport according to <br />applicable government regulations. <br />I further declare that this shipment of waste Is free of hazardous and mercury waste as deflned by the US cad a of federal <br />regulations and/or approprlate state rules and regullatlons. <br />nv <br />b ), .1,N u'l `r'--� tl— �' J'��Y— <br />Name of authorlked porion (print) • S <br />1 <br />Name o authorizad peraon (print) <br />Name of authorized person (print) <br />Brett Espicha <br />Date <br />05/27/2015 <br />Certificate of Denructlon <br />Autoclaved Name of authorized parson (print) Signature Date <br />Received Time Feb,25. 2016 11:52AM No -1498 <br />