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Feb, 25. 2016 11:54AM <br />Barnett Medical Se s, Inc <br />3670 Enterprise Ave <br />Hayward Ca 94545 <br />I=PA#CAL000404086 <br />Transporter 1D"691 <br />,"n erator: <br />Wine CsBUn" Care Center - Lodi <br />32.1 Ole -Rt njrn:r Read <br />UdI, CA 0524Q <br />5-10-429-0911 Ph <br />510266-0945 Fax <br />Contact: Pet <br />weekly , <br />Frequency of Service <br />g4g�75 <br />Pricing <br />No.8337 P. 46/56 <br />Date: <br />Manifest #: <br />Customer## 2560 <br />Work- fz09► a; -4.37M <br />Waste Collected: UN 3291 Regulated Medical Waste n,o.s. 6.2 PG II <br />Sherpa <br />Contalners Regulated MQdlcal Waste <br />Pharmarpotical <br />Size <br />13 Tmnafer Facillry: <br />0 0stmnetlon Faoliity: <br />0 Alternate Transfer Facility <br />D Alternate Restination Facility <br />O Destination Fadlity <br />Daniels ShalpsmaWams <br />Barnett Medical Services,lno <br />Daniels Sherpamart <br />CLutis Bay Energy <br />Photo Weals Recycling Inc <br />3870 Enterprise Ave <br />2,385 Arch Rd 11200 <br />4144 E. Therese Ave <br />3200 Hawkins point Rd <br />2980 Kerner Blvd gG <br />Hayward CA94645 <br />etoaklon CA05218 <br />Fresno CA 93726 <br />Baltimore MD 21226 <br />Ben Rafael CA 94901 <br />(310) 420.8911 <br />(610) 429.9911 <br />558934-8252 <br />(410),W-3228 <br />(415) 459-6807 <br />Permit # TS/OST 10® ., <br />Permit #1$/OST-55 <br />Pernill ft 2005-WMI-0038 <br />Permtl # pWR 122764 <br />Date <br />�1, _ Dat <br />Waste Collected: UN 3291 Regulated Medical Waste n,o.s. 6.2 PG II <br />Sherpa <br />Contalners Regulated MQdlcal Waste <br />Pharmarpotical <br />Size <br />Qty: Size Qty: Wt <br />Size Qty: <br />Up to; <br />3 gal <br />2 gal <br />20 gal <br />8 gal <br />4 gal <br />38 gal <br />9 gal <br />6gal <br />—'T—� <br />40 gal ! !v <br />12gal <br />8 gal <br />44 gal <br />18 gal <br />12 gal <br />Weight <br />`jai <br />Size Qty <br />ureight; <br />Dental Waste: <br />Trace Chernotherapy <br />Wt:. Size Qty: Wt <br />12 gal <br />18 gal <br />20 gal <br />38 gal <br />Weight jProduct belivered: <br />Itemf; Description: <br />AmaIgom:Sim_ QtyFixer., S122 Qty Developer_SIze Qty <br />Lead.,Size Qt Other --Size Qt <br />Other: ype Slze.w,�,Qt <br />Notes.- <br />O1� o <br />Qt: <br />Generator Certifieatio n; I herebycertlfy that thecontents of this consignment are fully and accurately described above by proper Shipping name <br />and are classified, packed, rrri�arked, and labeled, and are In all aspects in proper condition for transport according to <br />applicable government regulations. <br />I fufther declare that thf5 shipment of waste is free of ha rdous d mercury Wa as deli the US code of federal <br />regLllattons and/or appropriate state rules an g.sti.ns, <br />Generator (Customer). om 11 - .. 1�) b `Lj ^�jr <br />Name of authorized pers frnt) i nature Date <br />Route Driver Al k <br />Name ofauth rized person (print) Signature Date <br />Oertllficate of Destruction <br />Incineration <br />Name of authori,ed person (print) <br />Brett Espicha <br />Cerdflcete of Destructlon <br />AUtodaved Name of authorized person (print) <br />Received Time Feb.25. 2016 11:52AM No,1498 <br />Signature <br />Date <br />10/14/2015 <br />Date <br />