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Feb, 25, 2016 11:53AM <br />isBarnett Medical Se s, Inc <br />3670 Enterprise Ave <br />Hayward Ca 94545 <br />EPW-Al-000404096 <br />TransporterID#4891 <br />'X—N ierator: <br />Wine Country Care Center - Lodi <br />321 lAhxsr Turner Read <br />! rdi, CA 0240 <br />5 -IG -429-9911 Ph <br />510-2660945 Fax <br />Contact, Pat <br />No, 8337 P. 38/56 <br />Date: 08"4w --w <br />Manifest lu, ; 78120 <br />Customer# 2560 <br />Frequency of Service weekly <br />Pricing $4% per Month FLAT -RATE <br />M%rris: G3j -4 �7�D <br />Q'Ranator Facility: <br />IR Destination Facility: <br />0 Alternate Transfer Facility <br />Q Altemste Deelina en Facility <br />C1 Destination Faoillty <br />Dardelr SharpsmatVBMS <br />3670 Enterprise Ave <br />Barnett Medical Servloes,inc <br />2385 Arch Rd 0200 <br />Daniele 8harpamart <br />4144 E. ThereaeAve <br />Curtis Bay Energy <br />3200 HOWItina Point Rd <br />Photo Waste Recycling Inc <br />2880 Kerner Blvd #C <br />Hayward CA 94545 <br />(610) 428x9911(310) <br />Stockton CA 95215 <br />X429.8911 <br />Fresno CA 93728 <br />559-834-6252 <br />Baltimore MD a1226 <br />(410) 354-3228 <br />San Rafael CA B4901 <br />(415) 469-8807 <br />Date— <br />ermlt!#T6t08T100 <br />ParmltpT810ST-56 <br />Parmit4,t2005-WMI-0036 <br />Permit 0PWR122764 <br />Waste Collected: URI 3291 Regulated Medical Waste n.o,s. 6.2 PG II <br />Sharps Containers <br />RegWmtadAdLd1cal Waste <br />Pharmaceutical <br />Tran& Chemotherapy <br />Size qty: <br />Size Qty: Wt <br />Site Qty: Wt: <br />Size Qty: <br />Wt <br />Up to: <br />3 gal <br />2 gal <br />20 gal <br />a gal <br />12 gal <br />a gal <br />38 gal <br />9 gal <br />U gal <br />6 gal <br />a0 gal — <br />12 gal <br />20 gal <br />8 gal <br />44 gal <br />18 gal <br />38 gal <br />22 gal <br />Weight <br />.r-- al <br />Size Qty Weight <br />qua Delivered: <br />Weight: <br />Pathogen: <br />Item # Description: <br />Qt: <br />Dental Waste: <br />Amalgam Size City FIXer:Size Qty Developer: Size Qty <br />Lead:Size Qt Other: Size Qt <br />Other. Type Size Cit <br />Notes: ea acldl tub beychd (6) <br />Generator Certification; I herebytxrtlfy d1At th®content® ofthlsoonsignMent are fully and accurately described above by proper shipping name <br />and are classified, pecked, marked, and lab®lad, and are in allaspect9 In proper condition for transport according to <br />applicable government regulations <br />Generator (customer) <br />Route Driver <br />'—N <br />Certificate of DestrttcJon <br />Incineration <br />I further declare that this shipment of waste is free of hazardous and mercurywaste as defined by the US code of federal <br />tegulatlons and/or appropriate state rules and regulatlons, <br />>//V"/ I a' Gdj1;14ffZ. <br />Name of authorized person (print) Signature <br />Name 11'authorized person (print) signature <br />Name of authorized person (print) <br />Brett Espicha <br />Cerdfleate of Destructlan <br />Autoclaved Name of authorized person (print) <br />Received Time Feb•25. 2016 11:52AM No -1498 <br />Signature <br />Date <br />Date <br />08/27/2015 <br />nate <br />