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Feb, 25. 2016 11:55AM <br />III tsernett medical S es, Inc <br />r -i 3670 Enterprise Av <br />Hayward Ca 94545 <br />EPA#CAL000403598 <br />Transporter [D#4691 <br />�terator: <br />Wine Country Dare tenter - Lott <br />:QA'! V*stTumer PQad <br />Lodi, CA 06249 <br />510-429-9911 Ph 0 <br />510-2660945 Fax <br />Contact: Pal <br />Frequency of Service weekly <br />Pricing 4Q`76 <br />No, 8337 <br />P. 56/56_ <br />Date: <br />cede -&-j?- t5 <br />Manifest #: <br />85097 <br />Customer# <br />2550 <br />WOrg: (209) 334.37M <br />o Yransfer Flaky: <br />X Deatinallon Facility: t, Altemete llansfer FaeJOty <br />a Alternate Destination Faolllty <br />D Destination Facillty <br />Daniels SherpsmamBMS <br />Barnatt Medical SenAce9,inc <br />Danleis SharpamartCURIs <br />)3ay Fnetgy <br />Photo Waste Recycling Inc <br />3670 Enterprise Ave <br />2365 Ardh Rd y200 <br />41x4 �. Therese Ave <br />3200 Nawkl, Point Rd <br />2980 Kemgr sled uc <br />Hrtywatd CA 94545 <br />(510) 420-9811 <br />Stockton GA 9521$ <br />Fresno CAoom <br />559-834-6262 <br />Baltlmore MD 21226 <br />Ban Rafael CA 0401 <br />458-0807 <br />Patmn it7S•126 <br />(510) 42,9.9911 <br />Pe It tf TWOGT•100 <br />Pwtnit f# TS/03T4$ <br />((410) a64.322M <br />Formlt 0 2006-WMI.0036 <br />(415) <br />Permn 4 PWR 122764 <br />Date <br />44 gal <br />18 gal <br />38 gal <br />12 gal <br />Waste Collected: UN 3291 Regulated Medical Waste mo.s. 6,2 PG 11 <br />Sharps Containers <br />HggyIatedMadIcal Waste,Pharm <br />utleal <br />R ChemgheraQy <br />Size Qty: <br />Size Qty: Wt <br />Size Qty: <br />M. 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 3 6 <br />12 gal <br />20 gal <br />8 gal <br />44 gal <br />18 gal <br />38 gal <br />12 gal <br />Weight <br />Size qty <br />Welght <br />Pm ct Delivered: <br />Weight: <br />Pathogen: <br />Item # Description: Qt: <br />Dental Waste: <br />Amalgam: Size Qty Fixer; Size Qty Developer: Slae Qty <br />Lead:Size Qt Other;5►zen Qtl <br />Other: Type . Size Qt <br />Notes: v/uri- FB {. L 3 <br />3.1 <br />I� <br />Generator certification: I hereby certify that the contents of this consignment are fully and accurately deacribed above by proper shipping name <br />and aha classified, pecked, marked, and labeled, and am In all aspects in proper condition for transport ®wording to <br />applicable government regUMOns. <br />Generator (Customer) <br />Route Driver <br />Certificate of Destruction <br />Incineration <br />I further declare that this shipment of waste is tree of hamrdouland mercurywaste as defined by the US code of federal <br />fogylatlgns a%Vor appropriatestate totes and regulsdon6. <br />Zed person (print) I SIRAature <br />&6 P c e.'- <br />N8nis a9uthorized person (print) <br />Nam ofauthorized person (print) <br />Brett Esplcha <br />Certlfit:ate of Destruction <br />Autodaved Name of authorized person (print) <br />Received Time Feb,25, 2016 11:52AM No,1498 <br />5'gnature <br />Signature <br />Date <br />- Zpo( <br />Date <br />12/23/2015 <br />Date <br />