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Feb, 25, 2016 11; 48AM No, 8337 P, 5/56 <br />klarnett Medical Se s, Inc - 'v10=429-9911 Ph Dates- I�`I)L;, �w I' <br />67871 <br />30620 San Antonio 510-429-9914 Fax IMF Manliest r 2560 <br />Hayward Ca 94544 Customer# 2560 <br />Transporter ID#4.691 <br />'~-aerator: Contact: Pat Work: 334 -YM <br />Wine Count/ Care Cutter - Lodi weekly <br />32.1 West Turner Road Frequency of Service <br />Lodi, CA 98240 Pricing 188 per Monch RAT -RATE <br />a Transfer Facility <br />Barnett Medical Sarvbee,lnc <br />CA Deltlnatlon RORY! o A{temate Transfer F9oltay o Deetination Facility cl Alt@mate DOstlnaclon Feollltyt3 Altemale Transfer Facility <br />Barnett Medical Sarvloea,lno Realmiss Service® Photo Wasle Recycling Inc Cures Bay Energy Donlela 8harparnart <br />30620 San Antonlo St <br />Hayw&M CA 046" <br />2365 Arch Rd 0200 4900 E. Lincoln Ave <br />8toGkton CA 95215 Fowler CA 53625 <br />2990 Korner Blvd #C 3200 Hawkins Point Rd <br />San Roiael CA 84801 Baltimore MD 21226 <br />4144 t'-• Therese Ave <br />Freano CA 93725 <br />(510) 4299811 <br />Permit#TS-87 <br />(510) 429.9911 55B•B34-3333 <br />Permit#TSIOST-100 PormIt0T6.80 <br />(415) 459-8607 (d10) 38d.3228 <br />Permlt9PWR122764 Permit#2005-WMI-003® <br />559.834.6152 <br />PermltOTSIOST-55 <br />Date <br />Waste Collected: UN 3291 Regulated Medical Waste n.o.s. 5.2 PG II <br />Sharps Containers <br />Regulated Medical Waste Pharmaceutical <br />Trace Chemotharapv <br />Size Qty: <br />Size Qty: Wt Size Qty; <br />Wt: Size Qty: <br />Wt <br />Up t0: <br />3 gal <br />2 gal <br />7,0 gal 8 gal <br />12 gal <br />4 gal <br />38 gal 9 gal <br />18 gal <br />6 gal <br />40 gal 1 _ �.Fj 12 gal <br />20 gal <br />B gal <br />44 gal 18 gal <br />38 gal <br />12gal <br />Size Qty <br />Weight <br />="`,al <br />Pathogen: <br />Product Dellyered: <br />weight: <br />Item#t Description: <br />Qt: <br />Dental Waste: <br />An141S®m: Siz® Qty Fixer: Size Qty- <br />Leaol:Size Qt' other,.Sl2e Qt <br />Other: T pe Size_ <br />Notes: Uptot5 per f <br />ea addl tub beyond (0 ) <br />Generator Cert ficatlon: <br />Gen erator.(Custo Misr) <br />Route Driver <br />Certificate of Destruction <br />Inclnerstlon <br />Certificate of Destruction <br />AutodBved <br />Received Time Feb, 25 <br />Developer: Size Qty <br />I hereby certify that the contents of this constrimentare fully and occuratelyd®6edbed above by proper shipping name <br />end oar 44bsslrlad,pecked, marked, and labeled, and are In all aspects in proper condition for transport according to <br />applleable governmens ragulatton6• <br />I further declam thatthis'shipm ent of waste It free ofhowdousand rnercurywaste as defined by the US deo <br />regulations and/or approprlatestate rules and regulations. <br />Name of authorized person (prin 0 51gnature Da 't / <br />Name o authorized person (print)l SIgnaturl ate <br />Nana of authorized person (p6nn tur Date <br />Brett Espicha 01/08/2015 <br />Name ofouthodzed person(print) Signature <br />2016 11,52AM No -1498 <br />Date <br />