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Barnett Medical Se ces, Inc 510-4229-9911 Ph Date: 07101/2014 <br /> 30620 San Antonio St 510-429-9914 Fax Manifest#: 55324 <br /> Hayward Ca 94544 Customer# 2415 <br /> EPA#CAL000331285 <br /> TransporterlD#4891 <br /> ,nerator: Contact: Partin Gitdeman 'Work:(209)473-3004 <br /> Riverwood Health Cafe Center- Stockt "reekly <br /> Frequency of Service <br /> 5320 Carrington Circle <br /> Stockton,CA 95210 Pricing 40gal,>Fiat Date @$238 per month <br /> 1$65 adds tubs <br /> o Transfer Facility: N Destination Facility: o Alternate Transfer Facility o Destination Facility o Alternate Destination Facilityo Alternate Transfer Facility <br /> Barnett Medical Services,inc Barnett Medical Services,lnc Healthwise Services Photo Waste Recycling Inc Curtis Bay Energy Daniels Sharpsmart <br /> 30620 San Antonio St 2385 Arch Rd#200 4800 E.Lincoln Ave 2980 Kamer Blvd#C 3200 Hawkins Point Rd 4144 E.Therese Ave <br /> Hayward CA 94544 Stockton CA 95215 Fowler CA 93625 San Rafael CA 94901 Baltimore MD 21226 Fresno CA 93725 <br /> (510)429-9911 (510)429-9911 559-834-3333 (415)459-8807 (410)354-3228 559-834.6252 <br /> Permit#TS-87 Permit#TS/OST 106 Permit#TS-89 Permit#PWR 122764 Permit#2005-WMI-0036 Permit#TS/OST-55 <br /> Date _Date*Y <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG 11 <br /> Sharps Containers Regulated Medical Waste Pharmaceutical Trace Chemotherapy <br /> Size Qty: Size Qty: Wt Size Qty: Wt: Siz Qty: Wt <br /> Up to: 3 gal <br /> 2 gal 20 gal 8 gal 12 gal <br /> 4 gal 38 gal 9 gal 18 gal <br /> 6 gal 40 gal 12 gal 20 gal <br /> 8 gal 44 gal 18 gal 38 gal <br /> 12 gal Weight <br /> - 3al Size Qty Weight Product Delivered: <br /> .eight; Pathogen: Item# Description: Qt: <br /> Dental Waste: <br /> AmaIgam:Size Qty Fixe r:Size Qty DeveIoper:Size Qty <br /> Lead:Size Qt Other:Size Qt <br /> Other:Type Size Qt <br /> Notes: Hours: 8-6 <br /> Generator Certification: i hereby certify that the contents of this consignment are fully and accurately described above by proper shipping name <br /> and are classified,packed,marked,and labeled,and are In all aspects In proper condition for transport according to <br /> applicable government regulations. <br /> I further declare that this shipment of waste is free of hazardous and mercury waste as defined by the US cod of federal <br /> regulations and/or appropriate state rules and regulatlonst <br /> Generator(Customer) <br /> L c,,i, P, <br /> ame of authorized person(print) Ainature Dat <br /> Route Driver I /Y fA A hAlL <br /> Name ofaut oozed person(print) nature Date <br /> L;ertifiicate of Destruction <br /> Incineration Name of authorized person(print) 9Q�2� <br /> Dade <br /> Certificate of Destruction 'C'4 v ' <br /> Autoclaved Name of auth ized person(print) Signature Date <br />