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Feb.25.2016 11:51AM No. 8337 P. 28/56 <br />Barnett Medical Se s, Inc 510429=9911 Ph Date: 46/1012015 <br />®N 3670 Enterprise Aveqv 510266-0945 Fax Manifest #- 2�6n <br />ip Hayward Ca 94545 Customer## <br />EPA#CAL0004D4006 <br />�~ Transporter I0#4891 <br />'lerator: Contact. Pst A -M > M) 3j4 -3M0 <br />Wine Countrry Cara Center - Lodi weekly <br />321 WoretTumpr Load Frequency of Service <br />Lod;, CA 96240 Pridng $455 per M ntth FLAT RATF- <br />O Transrer Facility: <br />0 Des0natlon Facility: <br />❑ Alternate ri-anofer Facility <br />O Alternate 1006tinatloh 5eci6ty <br />O De tinallon Facility <br />Daniels Sharppamart/BM9 <br />3670 Enterpdee Ave <br />Barnett Medical Servire0nc <br />23t75A1n11 Rd 1t20A <br />Danlets Sharpsmart <br />41x4 E. Therese Ayp <br />CurOs Bay Energy <br />o2oo Ha�vkin. Point Rd <br />Photo waste Psoyoling Ino <br />2990 Ksrn®r Blvd #C <br />Hayward CA 54545 <br />(510) 429-9911 <br />Stookton CA 65215 <br />(610) 429.9911 <br />Fresno CA$$720 <br />659134.0252 <br />Baltimore Mb 21226 <br />(410) 3542226 <br />t3An Rafael CA 94901 <br />(415) 4�9-8807 <br />Date <br />Pofmit # TS/OST-106 Permit OTWOST SS <br />Dat 6 6� <br />Pvmlt N 2006-WMI-0039 <br />Parma PWR 122764 <br />Waste Collected: UN 3291 Regulated•Medical Waste n,o.s. 6,2 PG 11 <br />Sharps Containers <br />Re ulglod Medi al Waste <br />Pharmacautical <br />Trace Chemotherapy <br />Size Qty; <br />Size Qty: Wt <br />Size Qty: Wt: <br />Size Qty: <br />Wt <br />Up to: <br />3 gal <br />2 gal <br />20 gal <br />R gal <br />12 gal <br />4 gal <br />38 gal9 <br />g al <br />1 8 g al <br />.6 gal.. <br />40 gal �� <br />12 gal <br />20 gal <br />.8 gal <br />44 gal <br />18 gal <br />Be gal <br />12.gai. <br />Weight <br />!�;al <br />Size Qty Weight <br />Product Delivered: <br />Weight: <br />Pat^ hoeen: <br />Item 4 Description: <br />Qt: <br />t <br />Amalgam:Size Qty Flxer:Size Qty Developer;Size Qty <br />Lead;Size Qt,_,._ OthercSize Qt <br />Other: Type' Size Qt <br />Notes: ' err <br />ea eddl tub beyond (I;� <br />Generator Certification; I.herehycertif�yy Ahet lhecontents of this contignmentere fully end eccuratelydeacribed above by proper shipping name <br />and are Vaselfled, pecked, marked, and labeled, and are In fill espect9ln proper condition for transport according to <br />appllcab a governmen t regulations. <br />I further declare that this shipment of Waste Is free of hazardous and mercurywest®Bs defined by the US code of federal <br />it <br />regulatiionsand/or appropriate state rules and regulations. <br />Generator (Customer)N8 a ized person (printl signature/) bate <br />Route DrIver iff, AS <br />Certificate of Destruction <br />Incineration <br />Name 0authorized person (print) Signature <br />Nome ofoothorized person (print) <br />Brett Esplcha <br />06/18/2015 <br />Certificate of Destruction <br />Autoclaved name of authorized person (print) Signature Date <br />Received Time Feb, 25. 2016 11:52AM No -1498 <br />