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Feb, 25. 2016 11, 52AM <br />Barnett Medical Se s, Inc <br />Ia- , M100A • 3670 Enterprise Ave <br />N 'As fall <br />Hayward Ca 94545 <br />EPWAL000404090 <br />7ransponerID0891 <br />lerator: <br />Wine Country Care Center -'.Lodi <br />321 West Turner Road <br />Lodi, CA 95240 <br />Contact: P9t <br />No, 8337 P, 33/56 <br />Date; 07/z uzu•t:�- <br />Manifest #: 78123 <br />Customer# 2-560 <br />Frequency of Service • weekly <br />Pricing $455 Per tu)c11tP1 FLAT JRATE <br />V!3fli: (2A 5,',4-3760 <br />0 Transfer F=acility: <br />Waste <br />N Destlnatlon Facillty: <br />0 Alternate Tranafer F5GP01y <br />❑ Altemato Destination Facility <br />❑ Destination Facility <br />Daniels SherpsmanlISMS <br />3670 Enterprise Ave <br />aarnen Medical 6ervcBs,ino <br />2385 Arch Rd 0200 <br />Donlela Sbarpsmart <br />4144 l:, Therese Ave <br />Curtis Bey Energy <br />3200 Hawkins point Rd <br />Photo Waele ReCyoling Inc <br />2980 Kamer Blvd #C <br />Hayward CA 946445 <br />Stockton CA 95215 <br />Fresno CA 93726 <br />9all1mom MD 21226 <br />San Rafael CA 94901 <br />(510) 429-9911 <br />(510) 4z9-9811 <br />558-834.6252 <br />(410) 3543228 <br />(415) 459.8807 <br />,Date- <br />ate <br />Pettnit,OTS/OST106 <br />PwYnOTSIOST-66 <br />Permitq;Z006-tNM1-0036 <br />Permit 0 PWR 122764 <br />Waste Collected: UN 3292 Regulated Medical Waste rt.o.s, &Z Pe II <br />Sharps Qmtalners. <br />Regal ed M diewal <br />Wafite <br />-eutical <br />Trace Ch theta py <br />Size Qty: <br />Size Qty:. <br />Wt <br />Size Qty: <br />WC: Size Qty: Wt <br />Up to: <br />3 gal <br />2 gal <br />20 gal <br />_ <br />8 gal <br />12 gal <br />4 gal <br />38 gal <br />9 gal <br />18 gal <br />6 gal <br />40 gal <br />12 gal <br />20 gal <br />8 gal <br />44 gal <br />1$ gal <br />38 gal <br />12 gal <br />Weight <br />Size Qty <br />Weight 1EM01MG1 Delivered: <br />Weight; <br />Pathogen: <br />Item 9 Description: Qt; <br />Amalgam; Slze Qty FlXer. Size Qty, <br />Lead: Size QL Other: size (lt <br />Other: Type Size <br />Notes: s per <br />ea addl t1j'rx beyond (0) <br />Developer: Size Qty <br />Generator Certification: I herebycertif/ that the contents: of this Consignment aro (u11yY and accurately described above by proper shipping name <br />and are classified, packed, marked, and labeled, and are In oil9speco In proper condition for transport aceordingto <br />applicable government regulations_ <br />18irther declare that dtls shipment of waste is free of hazardous and mercury waste as defined by the us and a of federal <br />wiations and/or appropriate state rules and moulntions, <br />Generator (Customer) � ,, tr� — Ia <7 I^, <br />Rottto Driver <br />Ceftiffcate of DaAruLfion <br />Incineration <br />Name of cluti oriz6d person (print) <br />f <br />of 4nhol"IUd person (print) <br />Name of auth6rhed person (print) <br />Brett Espicha <br />signature <br />Certi9eate of Destruction <br />Autodaved Name of authorized person (print) Signature <br />Received Time Feb,25, 2016 11:52AM No -1498 <br />3— <br />Date <br />07/22/2015 <br />Date <br />