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Feb. 25, 2016 11 ; 54AM <br />Barnett Medical Se s, Inc <br />® 3670 Enterprise Ave <br />FY Hayward Ca 04545 <br />EPAC,AL000404096 <br />TransporterIQ94891 <br />�''ierator< <br />Wine Country Care Center - Lodi <br />321 WestTumiRrload <br />Lodi. CA. 96240 <br />51'0429r9911 Ph <br />510-2660945 Fax <br />Contact' Pat <br />wLAekIv <br />Frequency of Service <br />Pricing 40g$75 <br />No, 8337 P. 47/561 <br />Date: "itAIW &V 1 <br />Manifest #:2T2 <br />Customer# 25560 <br />Work. 334-370 <br />D Tranmfar FaeillN: <br />X Destination Faculty: <br />O Allarnele Transfer Facility <br />O Altamate Destination Facday <br />d Deetinadon Faculty <br />Daniels 5harpsmarUBtvi3 <br />Samett Medical Sartricea,lno <br />Danlels 8hsrpsmert <br />Curtis Bay Energy <br />Photo Wasle Recycling ino <br />3670 Enterpdes Ave <br />2286 Aroh Rd #200 <br />4144 E. Therese Ave <br />8200 HewkinB Point Rd <br />2980 Kamer Blvd #C <br />Hayward CA 94545 <br />Stocklon CA 06216 <br />Freano CA 93726 <br />Belllmore MD 2122e <br />San Rafael CA 94901 <br />(510)429-9911 <br />(510)429-9931 <br />699.034-6282 <br />(410)354-3z2a <br />(416)459-6607 <br />9 gal <br />Permil # T9/OST--106 <br />Perml(O TMST•06 <br />Permit# 2005-WM60036 <br />Permit 0 PWR 122784 <br />Date <br />20 gal <br />8 gal <br />44 gal <br />Waste Collected% UN 9291 Regulated Medical Waste n.o.s. 6.2 PG II <br />Containers <br />Regulated <br />nddical Waste <br />PharmMceutical <br />Trace Chemotherep� <br />Size Qty: <br />Size <br />Qty: Wt <br />Size Qty: Wt: <br />Size 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 />18 gal <br />6 gal <br />40 gal <br />�� <br />12 gal <br />20 gal <br />8 gal <br />44 gal <br />18 gal <br />98 gal <br />12 gal <br />Weight <br />Size Qty Weight <br />Product Delivered: <br />Weight: <br />atho en: <br />Item' Description: Qt: <br />Dental ' Ste <br />Amalgam:Size • Qty Fixer: Siza Qty Developer_Slze Qty <br />I.ead:5lze Qt_„_ Other.Size Qt <br />Other: Type Slze Qt <br />Notes-, Hours <br />Generator Certl9catio n: I hereby certify drat the contents of chis gonflgnMent ere fully and accurately described above by proper shipping name <br />and are classified, packed, marked, and labeled, and aro In ell espacU in proper condition for transport according t0 <br />applicable government regulations. <br />I further declare that this thlpment of Wage 15 free of hazardous and mercurywa5te as defined by the US code of federal <br />regulations and/or appropriate state rules and regulatlons. <br />Generator(Customer) ✓(�'li3,0' �� .r;�!� <br />Name of authorized person (print) Signature Date <br />Route Driver <br />Certificate of Destruction <br />incineration <br />Name ofiauthorized person <br />Name ofauthorized person (print) <br />Brett Espicha <br />Signature <br />li <br />Date <br />10/26/2015 <br />Certlfkate of Destruction <br />Autoclaved Name of authorized person (print) Signature Date <br />Received Time Feb. 25. 2016 11:52AM No.1498 <br />