Laserfiche WebLink
0 8 <br /> Barnett Medical Services, Inc 510-429-9911 Ph Date: <br /> W6,A -a qo506 <br /> k 3670 Enterprise Ave 510-266-0945 Fax Manifest#: <br /> 10 <br /> Hayward Ca 94545 Customer# 2232 <br /> EPA#CAL000403598 <br /> Transporter ID#4891 <br /> ierator: Contact: -ally sci3nk 'vvr-rK,IH 1`+?4f.5-2625 <br /> Stockton Hernatolociv Onocolociv -S`lqskulency of Service <br /> 2 1 a i F r;r r a;3 St 5 Y F r., F-L#,JRA7FE <br /> c.toci�toc, 6,,K4 Pricing <br /> n Transfer Facility: 09 Destination FadJity-- Y_Allanriala Transfer Facility A tomato Destination Facility ci Destination Facility <br /> Barnett Medical Services.Inc; C15 iolsShorparnart Xt'jurtis Bay Enorg Photo Waste Recycling Inc <br /> Daniels Sharpsma"MS y 2M Blvd <br /> M70 Enterprise Ave 2385 Arch Rd#200 4144 E.Therese Ave 3200 Hawkins Point Rd San Kamer Rafael CA 9-4NC <br /> 901 <br /> Hayward CA 94545 Stockton CA 95215 Fresno CA 93126 Baltimore MD 211226 <br /> (510)429-9911 (610)429-9911 559$34-6252 (410)354-3228 (415)459-8801 <br /> Permit N TS-125 Permit 4 TSIOST-106 Permit#TMST-66 Permit#2005-WMI-0036 Permit#PWR 122764 <br /> Date Dal. "16/(1 <br /> Waste Collected: UN 3291 Regulated Medical Waste in.o.s.6.2 PG If <br /> Shares Containers Regulated Medical Wmte Pharmaceutiol _Trace Chemotherap <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 /> 4gal 38 gal Z 7-0 9 gal 18 gal <br /> 6gal 40 gal 12 gal 20 gal <br /> 8 gal 44 gal 18 gal 38 gal 7, <br /> 12 gal Weight <br /> I lal Size Qty Weight Product Nllyersd; <br /> Weight: Pathogen; Item# Description; Qt: <br /> Dental Waste: <br /> Ama I ga m:S!ze_Qty—Fixer:Size Qty_Deve I ope r:51 ze—Qty <br /> — <br /> Lead:S[ze_Qt0ther:51ze Qt <br /> Other:Type Size_Qt-- <br /> Notes: Hours NI-Th 8-30-l):30 1 1:212L5. Fri P3 304 <br /> Generator Cerdfkation: I herebycertify 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 thatthis shipment o f waste is free of haz and mjKcurywaste asdjfn�ed the US code of federal <br /> re—milations and/or appy nat7tate rules a latio <br /> Generator(Customer) M <br /> Name of authorized person(print r SilinatureDate <br /> \\j <br /> Route Driver <br /> Name ofauthor ed person(print) Signature Date <br /> -Certificate of Destruction <br /> Incineration Name of authorized person(prInt) Signature Date <br /> Certificate of Destruction <br /> Autoclaved Name of au thorized person(print) Signature Date <br />