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Barnett Medical Sery es, Inc 510-429-9911 Ph 0 ®ate: 06/24/2014 <br /> 0-1k30620 San Antonio St 510-429-9914 Fax Manifest#: 5823 <br /> Hayward Ca 94544 Customer# 2410 <br /> EPA#CAL000331285 <br /> Transporter 113#4891aerator: Contact: Martin Gittle ,ran ork:(209)473.3004 <br /> Riverwood Health Care Center - Stockton weekly . <br /> 5320 Carrington Circle Frequency of Service <br /> Stockton,CA 95240 Pricing 40gal<}Flat Rate @$238 per month <br /> 1$55 addl tubs <br /> ❑ Transfer Facility: Olt Destination Facility. ❑ Alternate Transfer Facility ❑ Destination Facility ©Alternate Destination Facility❑ Alternate Transfer Facility <br /> Barnett Medical Services,inc Barnett Medical Services,inc Healthwlse 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 /> Heyward 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 659-834-3333 (415)459-8807 (410)354-3228 559.834.6252 <br /> Permit#TS-87 Permit#TS/OST-11 06 Permit#TS-89 Permit#PWR 122764 Permit#2005-WMI-0036 Permit#TS/OST 55 <br /> DateDate //y <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG 11 <br /> Sharps Containers Regulated Medical Waste Pharmaceutical Trage Chemotherapy <br /> Size Qty: Size Qty: Wt Size Qty: Wt: Size 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 /> 8gal 44 gal 18 gal 38 gal <br /> 12 gal Weight <br /> ;ai Size Qty Weight Prodg q Delivered: <br /> oveight: P o e : Item# Description: Qt: <br /> Dental Waste: <br /> Amalgam:Size Qty Fixer:Size Qty Developer:Size Qty <br /> Lead:Size Qt Other:Size Qt <br /> Other:Type Size Qt <br /> Notes: I'lours. <br /> Generator Certification: I hereby certify that the contents of this consignmentare fully and accurately described above by proper shipping name <br /> and are classified,packed,marked,and labeled,and are in all aspects In propercondition for transport according to <br /> applicable government regulations. <br /> I further declare that this shipment of waste is free of hazardous and mercurywaste as defined by the US code of federal <br /> regulations and/or appropriate state rules and regulations. / <br /> Generator(Customer) A I G ill <br /> Name of uthorized person(print) Sign ur Date <br /> P,k Lj t1 A d-dai 4 <br /> Route Driver <br /> Name o authorized person(print) nature Date <br /> -Certificate of Destruction <br /> Incineration Name of authorized person(print) tur Date <br /> Brett Espicha 6/26/2014 <br /> Certificate of Destruction <br /> Autoclaved Name of authorized person(print) Signature Date <br />