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Feb. 25. 2016 11:52AM <br />tsarnou Medical Se a, Inc <br />3670 Enterprise Ave <br />Hayward Ca 94545 <br />EPA#CAL000404090 <br />r�erator: TransporterID04891 <br />Wine Counter Cara 'Camel - Lodi <br />2221 Y kitt TLrner Road <br />Lodi, CA 95240 <br />510-429=9911 Ph <br />510-266-0945 Fax <br />Contact: Pat <br />No -8337 P. 30/56 <br />Date: 061sufalt, <br />Man(fest #: 78120 <br />Customer-#, 2560 <br />Frequency of Service Weekly. <br />Pricing $455 per Month FIAT RA.TFz <br />0 Transfer Facility: <br />00 De90natlon Facility: <br />C1 Attemate Transfer Facility <br />0 Alt®rmite Deetlnalloh Facillty <br />0 Destination Faculty <br />Dram®le Sharparuart/BMS <br />Barnett Medical Servlogs.lrrc <br />Daniels Oharparnert <br />Curtis Bay Energy <br />Photo Mate Recycling Inc <br />3670 Enterpnge Ave <br />Hayward CA 94545 <br />238E Aroh Rd 0200 <br />8tcekton CA 96216 <br />d144 E. Thorsae Ave <br />Ftesno CA 93725 <br />3200. Hawldlts Point Rd <br />BslVrnore MD 21226 <br />2980 Kemor 51vd &C <br />San Rafael CA 94901 <br />(510)429-9911 <br />(510)428-9911 <br />559-834-6252 <br />(410)364.3228 <br />.(415)459-8807 <br />4 gal <br />permit # TS/OST-106 <br />Permit itT81097-6 6 <br />Perrnit920o5-WMt-0036 <br />Permit # PWR 122764 <br />6gal ^� <br />40 gal <br />12ga1 <br />20 gal <br />bate Dare/j"� <br />Waste Collected: UN 3294 Regulated Medical Waste n.o,s. O.ZPG 11 <br />Sharps Contain®rs <br />I Regulated Metrical Waste <br />Pharmaceutical <br />Trace Chemotherap2 <br />Size Qty; <br />Size Qty: Wt <br />Sitz Qty: <br />Wt. 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 />6gal ^� <br />40 gal <br />12ga1 <br />20 gal <br />8 gal <br />44 gal <br />18 gal <br />38 gal <br />12 gal <br />Weight <br />Size Qty <br />Welght <br />Product Wivered: <br />Weight. <br />thg en: <br />Item # <br />Description: Qt: <br />�-, <br />Amalgam: Size Qty FIX®r: Site Qty_ Developer; Size Qty <br />Laad:Slze Qt—„ Other:5ize Qt <br />Other: Type Size Qt <br />Notes:,oa addl tub Leyond (5) <br />Generator Cartifleatiop; <br />Generator (Custonter) <br />Route Driver <br />Certificate of Destruction <br />Incineration <br />I hereby eErtify that thecontents of thl9 con elgnmant Ire fullyy ttnd accurately described above by proper shipping name <br />and ere classified, packed, marked, and labeled, and are Inallaspects in proper conditlonfnrtransportaccording to <br />applicable government regulatlom. <br />I further declare that this shipment of waste is free of hazardous and mercury waste as dsflned by the US cod eo f federal <br />regulations and/or appropriate state Mules and regul9U n®. <br />Q r — ff— - <br />_�_ % - r.�.s�g <br />Name of authorized person (print <br />"W"Id (49 Y <br />Name of futhorizeld person (print) <br />Name ofauthorized person (print) <br />Brett Espicha <br />Cert3Ficate of Destruction <br />Autodaved Name of authorized person (print) Signature <br />Received Time Feb -25. 2016 11:52AM No.1498 <br />� - t <br />Signature <br />Date <br />'e 0/1 <br />ate <br />Date <br />07/01/2015 . <br />Date <br />