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Feb, 25. 2016 11:52AM <br />Barnett Medica( Se s, Inc <br />1 3670 Enterprise Ave <br />Hayward Ca 94545 <br />EPA#CAL000444096 <br />"�lerafOr: lilaansponer ID#4801 <br />Wile Coun iry Care Center - Lodi <br />3211A/est Turner Road <br />Lodi, CA @6240 <br />iK-161MILIREN <br />Contact: * Pat <br />No -8337 P. 32/56 <br />Date: 0711412015 <br />Manifest #; 79122 <br />Customer# 2560 <br />Frequency of Service weekly <br />Pricing $456 per Month FLA RATE <br />Work: (209) 33A 37E4 <br />C1 Transfer Feolltly: <br />Daniels SharpemaMOMS <br />W Deadnation Facility. <br />eamett Medical Setvices,ine <br />Q Anemaie Trenefer Facility <br />Daniela Sharpsmart <br />' Q Alternate Destination Facility <br />Curtis Bay Energy <br />O Destination Facility <br />Photo Waste Reayeilgp Pic <br />3670 enterprise Ave <br />fiayward CA 94545 <br />2385 Aroh Rd 9200 <br />Stockton CA 95215 <br />414d e. TheressAve <br />Fresno CA Q372,111 <br />3200 Hawkins Point Fid <br />Baltlmote MD 21226 <br />2989 Kamer Btvrt go <br />San Rafael CA 94901 <br />(410) 42"911 <br />(510) 429-9911 <br />559434-6262 <br />(410)38d-3226 <br />(415) 456.8607 <br />Data <br />Parmlt#TWOST--106 <br />---�a�S <br />Perm11#TS/oST.55 <br />Pemtlt*Z006WMt•0099 <br />FaMlt # PWR 122754 <br />Waste Collected: UN 3291 Regulated Medical Waste nma, 62 PG II <br />CWgpi= <br />Regulaicil <br />Medical Waste <br />Phannaceutical <br />Tracebemoiheranv <br />Size Qty: <br />51ze <br />Qty: Wt <br />Size Qty: <br />Wt: Sire Qty: Wt <br />Up to: <br />3 -gal <br />2gal <br />209al <br />�^ ^� <br />8 gai <br />12 gal <br />4 gal <br />38 gal <br />9 gal <br />18 gal <br />6 601 <br />40 gal <br />LL7 <br />17 gal <br />20 gal <br />8 gal <br />44 gal <br />18 gat <br />38 gal <br />1.2 gal <br />Weight <br />�a1 <br />Size Qty <br />Weight <br />Pr uct Delivered: <br />Weight: <br />P-mtho en: <br />Item # Description: Qt: <br />Amalgam:Slze Qty Fixe r: Size Qty DeveIoper:5ire_ Qty <br />Lead: Size Qt other: Slze Qt -- <br />Other: T e Size Qt <br />Notes: upto(e)40's V55 Hour: 8-5 <br />ea addl tub beyond (0) <br />Generator Certiflestion: I herebycertify thatthecontents ofthis consignment are fully and accuratelydescribad 9bove by proper shlpping name <br />end aro classified, packed, marked, and labeled, and are in all aspects In proper condttlon for transport according to <br />appllrablegovetnrtlent regulations. <br />I further declare that this shlpment of waste i e f hazardous and rnercuryw ned US code of federal <br />regulations/anld/or appropriate State rules d re lations_ <br />Generat®r• (Customer) `—'v t �v'1 r'TV <br />Narne of authorized persc t) I Date <br />Route Driver IF A L^P Vt.&.----------------------- <br />r� <br />Name of futhodzed person (print) Signa ure ate <br />Certiltrate of Destruction <br />Incineration <br />Name of authorized person (print) <br />Brett Esplcha <br />Certificate of Destruction <br />Autoclaved Name of autftorized person (print) <br />Received Time Feb,25, 2016 11:52AM No,1498 <br />Signature <br />Date <br />07/16/2015 <br />Date <br />