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Feb, 25. 2016 11; 53AM <br />Barnett Medical Se s, Inc <br />!a 3670 Enterprise Ave <br />Hayward Ca 94545 <br />EPA#CAL000404096 <br />(� Tran3porter ID#4091 <br />'lera'tor: <br />Nne Colun" Care Certer - )r ods <br />821 Vksti'umer Road <br />L.odl, CA D6240 <br />510-4299911 Ph <br />510-266-0945 Fax <br />Contact: Pat <br />No, 8337 P. 37/56 <br />Date: 08/18/2015 <br />Manifest M. 79i27 <br />Customer# 2560 <br />Frequency of Service weekly <br />Pricing X455 per MorM FLAT PRATE <br />WO(o : (a'09) 8S4 -N80 <br />O Transfer Facility: <br />2111 Deatination Facility <br />O Alternate Transfer Facility <br />A Alternate Destination Fecilky <br />D Destination Faculty <br />Denials SharpsmarVSMS <br />Barnett Medical aervlces,inc <br />Daniels- Sharpsman <br />Curtla Say Energy <br />photo Waste Recycling Inc <br />300 Enterprise Ave <br />2386 Arch ted 0200 <br />4144 E. Therese Ave <br />$200 Hawktna Point Rd <br />2980 Kerner Blvd #0 <br />Hayward CA W46 <br />Stocklon CA 95215 <br />Fre4no CA 93725 <br />Baltimore MD 21226 <br />San Rafael CA04901 <br />(510) 420-9911 <br />(610) 429-9911 <br />559-83d.6252 <br />(410) 354-3z26 <br />(415) 459-8807 <br />Date <br />@r t /b Tl3/OST 1i;;�� <br />ate <br />Permit u TSIOST-65 <br />Permit N 2005-WMI-0036 <br />Permlt 0 PWR 122764 <br />Waste Collected: UN 3291 Regulated Medical Waste n.o.s. 6.2 PG II <br />2orps Containers <br />Regglated <br />Medical Waste <br />Pharrneceuticgj <br />Trace Chemotherspy <br />S>� Qty: <br />Size <br />Qty: Wt <br />Size qty: _ <br />Wt; Size Qty: Wt <br />Up to_ <br />3 gal <br />2 gal <br />20 gal <br />8 gal <br />12 gal <br />4gal <br />38 gal <br />9gal <br />18gal <br />6 gal <br />40 gal <br />� <br />12 gal <br />20 gal <br />8 gal <br />44 gal <br />18 gal <br />38 gal <br />12 gal <br />Weight <br />l <br />Size Qty <br />Weight <br />Product Delivered: <br />Weight: <br />Pathogen: <br />Item # Description: Qt' <br />Dental Waste: <br />AmaIgam:S1Ze Qty FixenSlze Qty <br />Lead: Size Qt Other.Slze Qr- <br />other: Type Size <br />Notes: lip o f ®}4Q'$ per MG. -$76 1 - <br />ea <br />ea addl but IOelJgnd (d) <br />DoVeIopar: Slxe qty <br />Generator Certifleatlon: I herebycertify that the contents of this con6lgnmantara fullyy and accuratelV described above by proper Shipping name <br />and are clnsslfled, packed, marked, and labeled, and ars In allasp4Ct8 In proper condition fortransport according to <br />applltable government ►egulattons. <br />1 further declare that this shipment of w free of hazardous nd mercury Waste as defined by the VS and eof federal <br />regulations and/or appropriate state a$$ regulations. <br />Generat u&tomer) S gvn <br />Name of awhorized person (print) Data <br />Route Driver I1 <br />Nams of a horized person (print) Signature tg <br />'Uttiftrate of Destruction <br />incineration Name of authorized person (print) �e ere Date <br />Brett Espicha 08/19/2015 <br />Certificate of Destruction <br />Autodaved Name of eumarized person (print) Signature Date <br />Received Time Feb,25, 2016 11:52AM No.1498 <br />