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Feb, 25. 2016 11:53AM <br />Bamett-Medical Se00s, Inc <br />w� 3670 Enterprise•Ave <br />Hayward Ca 94545 <br />E PA90AL000403598 <br />(-.erator: Transponar IU4591 <br />� <br />Wine Courdyv Core Center - Lodi <br />321 `.-�etTurnerRoad <br />Lodi. Ca Q5240 <br />No, 8337 P. 42/56 <br />510-429-9911 Ph 10 Date: <br />510-2660945 Fax Manifest ##: 06942 <br />Customer# 256Q <br />Contact: Pat WPM: 01209) 334-37iki <br />Frequency of Service :daekty <br />Pricing 409$76 <br />o Transfar Facility: <br />04 Deetln®tlon Fedlilty <br />o Alternate Transfer Facility <br />p Alternate Destination Faolllly <br />a Destination FeelUty <br />Daniela Sharpsma'VBMs <br />BameTt Medical Serdices,lnc <br />Daniels SharpsmartCuRie <br />Bray Energy <br />Photo Waste R@cycling Inc <br />36>0 Onterpdse Ave <br />2365 Arch Rd 11200 <br />4144 �. Therese Ave <br />3200 HaWkM Point Rd <br />2980 Kerner Blvd #0 <br />NayWard CA 94649 <br />Stockton CA 95215 <br />rre9rlo CA 93728 <br />6allfmors MD 21226 <br />Sen Rafael CA 94901 <br />(510) 429.9911 <br />(610) 42a-9911 <br />659-834-6262 <br />(410) 354-5228 <br />(419) 469.6907 <br />permit#TS-125 <br />PermitOTWO81' 08/�q�4 <br />PermttbTS/O5T55 <br />Pormlt02005-WMI-0036 <br />Permit# PWA92270A <br />Dele <br />Date <br />Weight <br />mal <br />Waste Collected: UN 3291.Regulated Medical Waste n.o,sr 6.2 PG 11 <br />Sharps C.QnjajO&rs <br />Regulated Medical Waste <br />Pharmaceutical <br />Trace Chemotherapy <br />Size Qty: <br />Size Qty: Wt <br />Size Qty: Wt: <br />SIIzz , Qty: Wt <br />Up to: <br />3 gal <br />2 gal <br />20 gal <br />8 gal <br />12 gal <br />4 gal <br />38 gal <br />9 gal <br />1B gal <br />•6gal <br />40gal �_ <br />12 gal <br />20gal <br />8 gal <br />"gal <br />18 gal <br />38 ga l <br />12 gal <br />Weight <br />mal <br />Size Qty Weight <br />Produeljycred: <br />Weight: <br />Pathogen: <br />Item i# Description: Qt: <br />Amalgam: Size Qty fixer.Slze Qty Developer: Size Qty <br />Lead.,Slze Qt O.thenSize Qt <br />Other:'T. rpe Size. Qt <br />(Votes: Houfs e-5 <br />denerator Certification: I herebyearlIfy that the contents of this consignment are fully and eccureselydescrfbed above by proper shipping name <br />and are clatsif ed, packed, rnarlosd, and labeled, and are in allaspects In proper condition for transport according to <br />applicable government regUlolon9. <br />Generator (Customer) <br />Route Driver <br />/"^. <br />Certificate of Destruction <br />Incineration <br />I further dedarethat chis shipment of <br />regulations and/or appropriate state r <br />free of haztrdousand mercurvwaste as defined by the Us code of federal <br />regulations. I ^ _ <br />Name of authorized person (print) attire D e <br />Name of authoriza person (print) Signature ate <br />Name of authorized person (print) <br />Btett E5picha <br />Date <br />01/04/2016 <br />Certificate of Destruction <br />Autodaved Name of a* uthu Ozed person (print) Signature Date <br />Received Time Feb,25, 2016 11:52AM No -1498 <br />