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Feb.25.2016 11:54AM No. 8337 P, 44/56)5 <br />Barnett Medical Se s, Inc 510-429-9911 Ph ® ®ate: "01607 <br />�a 3670 Enterprise Ave 510-2660945 Fax Manifest M 2160 <br />Hayward Ca 94545 Customer# <br />EPA#CAL000404096 <br />:�•� Transporter ID#f4691 <br />aerator: <br />Wine Country Care Center - Lodi <br />321 IM-st Turner Road <br />Lodi, CA 05240 <br />Flat <br />Contact: <br />weekly <br />Frequency of Service <br />40g$7F <br />Pricing <br />1W01K' tX9) 3U -37M <br />D Tranefer FaafHfy: <br />0 Destination Facility: <br />b Alternate Transfer Facility <br />o Altemata beetlnaticn Facility <br />Q Destination Facility <br />Daniels SharpemanAMB <br />Barnett Me41oal Services,lnc <br />Daniels Sharpsmarl <br />Curtis say Energy <br />Photo Waste Recycling Ina <br />3670 EnterprlseAve <br />2389Arcat fid 0200 <br />4144 E. Therese Ave <br />3200 Hawkins Point Rd <br />2.980 Kerner Blvd #C <br />Heyward CA 94545 <br />Stockton CA 96218 <br />Fresno CA 88726 <br />Behimora MD 21220 <br />San Refeel CA 94801 <br />(510)A28•BB11 <br />(610)429-9911 <br />669-9348252 <br />(A10) 0044226 <br />(415)489-8807 <br />Data <br />Parnl,210ST.106 �1c1 <br />Permit#TS/0ST-SS <br />Permit#2005-WMI-0038 <br />Permit PPWR 122764 <br />9 gal <br />LDale J� j <br />6 gal <br />40 ga l <br />Waste Collected: UN 3291 Regulated Medical Waste n.o,s. 6.2 PG 11 <br />SharggContainers <br />Blogged <br />Medical Waste <br />pharmaceutical <br />IfaCe Chemotherapy <br />Size Qty: <br />Size <br />Qty: Wt <br />Size Qty: Wt: <br />Size <br />Qty: Wt <br />Up to: <br />3 gal <br />2 gal <br />20 gal <br />B gal <br />12 gal <br />4 gal <br />38 gal <br />9 gal <br />18 gal <br />6 gal <br />40 ga l <br />12 gal <br />20 gal <br />8 gal <br />44 gal <br />18 gal <br />38 gal <br />12 gal <br />Weight <br />�;al <br />Size Qty WeightProduct <br />Qallygred: <br />Weight: <br />Pathoeerti <br />Item 1# <br />Description: Qt: <br />Dental Waste; <br />Amalgams Size Qty Fixer. Size Qty <br />Lead-5lze QL Other: Size Qr <br />Other: Type SIzE <br />Notes; <br />Generator Certification.- <br />Generator <br />ertification: <br />Generator (Customer) <br />Route Driver <br />Certificate of Destruction <br />Incineration <br />Developer: 5lze Qty I <br />Qt <br />herebycertifv that theconterrts of this consighmentare fully and tar:curately described above by propershlpp(ng name <br />and ®re elarslfled, packed,hl�arked, and labeled, and are in all aspects in proper condltlon for transport according to <br />applicable governmen t reguletfora. <br />I further declare that this shipment of w ste iLulefions. rdoue m d mercury waste a5 deflned by the US cod e of federal <br />��Mre1g/vllatlo�nns and/or appropriate state rule n <br />A11 rY `O [.J �. <br />Name ofeuthorized person (print) / Signature <br />Name o eutharized person (print) Signature <br />Name of authorized person (print) <br />Brett Espicha <br />Certificate of Destruction <br />AUtodaved Name of authorized person (print) <br />Received Time Feb.25. 2016 11:52AM No.1498 <br />Signature <br />Date Q <br />t <br />to <br />Date <br />09/30/2015 <br />Dat4 <br />