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Feb -25.2016 11:51AM <br />Barnett Medical Se s, Inc <br />a 3670 Enterprise Ave <br />Ha and Ca 94545 <br />EP <br />A#CAL000404096 <br />Transporter 113#4891 <br />'erator: <br />Wine C.ou >Itry Care Center - Lodi <br />321 WostTumer Rriad <br />Lodi, CA 0524Q <br />No, 8337 P. 26/56 <br />51 CI -4299911 Ph Date: f191t,4fZ-v 1-a <br />510-266--0945 FaX Manifest #., ����� <br />Customer# 2560 <br />Contact: Pat • work: (guy) <br />Frequency of Service -We e • kly' <br />Pricing $955 Per Monrh FLAT -RATE <br />0 Tranefer Fgolllry: <br />M Destination Facility_ <br />Q Alternate Transfer Facility <br />d Alternate DesOnatlon Paoli ty <br />0 Destination Facillty <br />Daniels SharpsmarVIVO <br />-Barnett Medical Servicesjnc <br />Denlole 9herpsmart <br />Curtis Bey Energy <br />Photo waste Recycling Inc <br />3670 Enterprise Ave <br />2386Aroh Rd 02V0 <br />4144 E. -rheros®Ave <br />3200 Hawkins Point Rd <br />2960 Kamer Blvd #C <br />Heyward CA 94645 <br />Stockton CA96216 <br />Fresno CA•93725 <br />Baltimore MD 21226 <br />San Kafeel OA 94001 <br />(510)429.6811 <br />(510)428-9911 <br />559-634.6262 <br />(410)3SA-3228 <br />(415)450-8807 <br />20 gal <br />Permit *TS/OST-106 <br />Parmlt O T010ST-65 <br />Permt 9 2005•WMI.0088 <br />PettpltO PWR 122764 <br />Dale <br />_7�DatS <br />Weight <br />mal <br />Waste Collected: UN 3291 ReguWated Medical Waste n.o.s. 6.2 PC•e II <br />Regulated Medical Waste <br />PharMaceutjol <br />Trace Cheoldberapy <br />Size Qty: <br />Size Qty: Wt <br />Size Qty; <br />Wt: Size Qty: Wt <br />Up to: <br />3 gal <br />Z gal <br />20 gal <br />B gal <br />12 gal <br />4 gal <br />38 gal <br />9 gal <br />is gal <br />6 gal <br />40 gal _�� <br />12.ge1 <br />20 gal <br />8 gal <br />44 gal <br />18 gal <br />38 gal <br />12 gal <br />Weight <br />mal <br />Size Qty <br />Weightr1tre <br />o lu Delivered; <br />Weight: <br />Pathogen: <br />m 4 Description: Qt: <br />Dental Waste: <br />AmaIgo rn:Size Qty Fixer.Slxe Qty Developer:Size Qty <br />Lead: Size Qt_ Other. Size Qt <br />Other•Ty'pe Siz t <br />11iOteS, ea addl turf bey ar-d (6) <br />Generator Certification: I hereby certify that the contents of this cansignmentare fully and accurately described bboVe by proper shipping name <br />and are classified, packed, marked, and labeled, and are In all aspects In proper condition far tr3h6port according to <br />eppiltable government regulations. I <br />I further declare that this shipment of waste i e of hazardous and m rc y waste es defined by the US cod a of federal <br />regulations and/or appropri t state tures B d gulations- <br />Gen erator (Customer) CAW CA Y) � <br />U'21 <br />Name of authorized person (print) Sign r Date <br />Route Driver <br />�—� Name 10 uthorized person (print) Sigmtu a jDatel <br />Certificate of Destruction <br />Ihelneratlon Name ofauthorized person (print)Date <br />Brett Espicha 06/04/2015 <br />Certificate of Destnictivn <br />Autodaved Name of authorized person (print) Signature Date <br />Received Time Feb,25. 2016 11:52AM No,1498 <br />