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Feb. 25, 2016 11:53AM <br />Barnett Medical 5e s, Inc <br />3670 Enterprise Ave <br />Hayward Ca 94545 <br />EPA#CAL000404096 <br />Transportor ID#4891 <br />r Aerator: <br />Wire Country Care Center - Lodi <br />321 Wast Tu", r Rasd <br />Lodi; CA Q5240 <br />O Transfer Facility: <br />Daniels sharpsmatt/BMS <br />3®70 Enterprise Ave <br />Heyward CA 04M <br />(51o)429-9911 <br />Date— <br />M Deatinatlon Feclllty: <br />Barnett Medical Sarvices,lnc <br />2395Arch Re 0200 <br />Stockton CA 95216 <br />(510) 429-9911 <br />PenpnO TS/0ST-106 <br />bateC�- <br />510-428-9911 Ph <br />510-266®0945 Fax <br />Contact: !'at <br />No.8337 P. 40/56 <br />Date. - 09Ju6r4v-s�) <br />Manifest #: 804.1 <br />Customer# 264 <br />rrequency of Service vfeekly <br />Pricing $05 per Month FLAT RATS <br />INW. (21N) 334-3780 <br />0 Alternate Transfer Facility <br />0 Alternate Destination Facility <br />0 Destination peollity <br />Daniels Sherpsmart <br />Curtis Bey Energy <br />Phoeo waste Recycling Inc <br />4144 E. Therese AV& <br />3200 Hawkins Point Rd <br />2800 Kerner Blvd #C <br />Prean CA 93T2.5 <br />BeAlmore MP 21220 <br />San Rafael CA 94901 <br />r3tf8 93a•0262 <br />(410) 364.3226 <br />(415) 469.8807 <br />Permit d T9l0ST 6S <br />Permit 4 2005-WMI.0038 <br />Permit # PWR 122764 <br />Waste Collected: UN 3291 Regulated Medical Waste n.o.s. 6.2 PG II <br />.harlas Cantatner5 <br />Regulated Medical Waste <br />Pharme 'cal <br />Size Qty: <br />Size Qty: Wt <br />Size Qty: <br />Up to: <br />3 gal <br />2 gal <br />20gal <br />S gal <br />4 gal <br />38 gal <br />9 gal <br />6gal <br />40 gal ( <br />12 gal <br />8 gal <br />44 gal <br />18 gal <br />12 gal <br />Welght <br />"")31 <br />Size Qty <br />brace Chemotherapy <br />Wt: Size Qty; Wt <br />12 gal <br />18 gal <br />20 gal <br />38 gal <br />Weight <br />Weight; I Item # <br />Dental Waste: <br />Anna lgam:Slto_ Qty Fixer: Size Qty <br />L®ad:5Ue Qt Other; Size Qt <br />Other: Type Size <br />Notes: u ct s PLC FOU ` <br />ea arid! kuta beyond (6) <br />Devaloper.Si2e Qty <br />re reo: <br />Description: Qt: <br />Generator Certlticatlon: I herebyrertify that thecohtent6 of Shis oonslgnmentare fully and accurately described above by proper sh)pping name <br />end ere gqlassified, packed, marked, and labefado and are lm all aspects in proper condition for tronsport according to <br />eppllc®ble government regulations. <br />I further declare that this shipment of waste Is free of hazardous and mercury waste as defined by the U5 cod a offederal <br />t4NaMeuthorixed <br />ons and/o appropriate tate rulaa and resutatlons. <br />Generator (Customer) <br />person (print) 5ignatur Date <br />Route Driver/ <br />Name authorized person (print) S)gnat a Dat <br />Certificate of Destruction <br />incineration Name afauthorized person (print) <br />Brett Espicha <br />Certificate of Destruction <br />Date <br />09/09/2015 <br />Autoclaved Noraid of authorized person ( print) Signature Date <br />Received Time Feb.25, 2016 11:52AM No.1498. <br />