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Feb, 25, 2016 11:52AM <br />Barnett Medical Se s, Inc <br />Z 3670 Enterprise Ave <br />Hayward Ca 94545 <br />EPOCAL000404096 <br />TransponerlDtt4861 <br />�`rrator; <br />Isle Countfy �are Center -Leda <br />t- <br />32 -1, W@St Tumer Road <br />Lodi, CA 95240 <br />510-423-9911 Ph <br />510266-0945 Fax <br />Contact, .Pat <br />No. 8337 P. 29/56 <br />Date: 0614,;je-U I <br />Manifest #: 79179 <br />Customer# 2560 <br />Frequency of Service . - Weekly <br />Pricing <br />$4,61t-ner Month FLAT -RATE <br />Wolk. W.4) 339-37% <br />O Transfer Facility: <br />M DoWetion Facility: <br />0 Altemets Transfer Facility <br />U Alternate Destination Fadpty <br />Q Destination Facility <br />Daniela SherppemarNeMS <br />Barnett Medical 8ervices,hic <br />Danlele Sharpatnan <br />Curtis Bey Energy • <br />Photo Mate Reeydtno Inc <br />3®70 EntarpAaa Ave <br />2385 Arch Rd #200 <br />4144 E. Therese Ave <br />3200,Hawklns point Rd <br />2980 Kamer Blvd NC <br />Hayward CA 94646 <br />Slackton CA 85215 <br />Fresno CA 93725 <br />Baltimore MD 21226 <br />San Rafael CA 64901 <br />(510)429-9911 <br />510)429-9911 <br />$59.834.6252 <br />(410) 354-3228 <br />(415)459-8807 <br />9 gal <br />Permit 0 T8108T 108 <br />PermiE4 TSIOST- 90 <br />Permit # 2005-WMI-006 <br />Permit A PWR 122784 <br />Dale <br />�je —Dat <br />a gal <br />44 gal <br />Waste Collected: UN 3291 Regulated Medical Waste n.o.s. 6.2 PG 11 <br />Shar,U5 Containers <br />Regulated <br />Medical Waste <br />Pharmaceutical <br />Trace Chemotherapy <br />Sag Qty: <br />Size <br />QtyWt <br />Size Qty: <br />Wt: Size 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 />— gd <br />12 gal <br />20 gal <br />a gal <br />44 gal <br />18 gal <br />38 gal <br />12 gal <br />Weight <br />al <br />Size Qty <br />Weight <br />rdudDellyehed; <br />Weight: <br />Pat <br />m 4 Description: Qt: <br />D®ntal Waste• <br />Amalgam: Size Qty Fixer: Size qty DBveloper:Size Qty <br />Lead: Size Qt Other Size Qt <br />Other: Type Size Qt <br />w r <br />NoCt?s: • ea acid) tub beyond (6) <br />Generator Certification I hereby certify that theC0nteht9 of this oonsl®nmentare fully and accurately duacrfbad ebove by proper shipping name <br />and em classified, packed, marked, and labeled, and are in all aspects In proper conditlon for transport according to <br />applicable government regulations. <br />I further de -dare that this shipment of Wa5telStrif of ha2ardous and mercury waste es defined by the Us code of federal <br />�. `regulations and/or appropriate state rU)eB andr ula0 ons. <br />Generator (Customer) <br />Route Driver <br />r <br />Certificate of Pestruictiorl <br />Incineration ' Nema of authorized person (print) <br />Brett Esplcha <br />Name ofauthorized person (print) <br />Name ojauthorized person (print) $Ignafure / Date <br />Certificate of Destruction <br />Autodeved <br />Received Time Feb, 25 <br />Name Of authorized person (print) Signature <br />2016 11:52AM No.1498 <br />Date <br />06%242015 <br />Date <br />