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51 Uzw29-9911 Ph 16 Date: 07141 12411 <br /> 7 2 <br /> Bamett Medical St ces, Inc Manifest#: 18468 <br /> 30620 San AntoniCSt ' 5"10-429-904 Fak- Customer r# 2232 <br /> Hayward Ca 94W <br /> EPA#CAL000331285 <br /> Transporter I D#4891 Contact: <br /> Generator: <br /> Frequency of Service <br /> Pricing <br /> v4--Ajtama:e Qransfer Facility a Destination Facility Alternate Destination Facility <br /> o Transfer Facility: X Desflinon Facility: All Inc P9(Healthcare Environmental <br /> Barnett Medical Services,inc Barnett Medical Services,inc Alternate <br /> Sharpsmart Photo Waste Recycling 1420 40th St NW <br /> 4144 E.Therese Ave 2980 Kamer Blvd#C <br /> 3W20 San Antonio St 2385 Arch Rd#200 Fresno CA 93726 San Rafael CA 94901 Fargo ND 58102 <br /> Hayward CA 9450 Stockton CA 95216 (416)459-8807 (701)282-7373 <br /> (510)42"11 (510)429-9911 559-834-6252 permit#PW <br /> 122764 Permit#ITF-208 <br /> Permit#TS-87 Pe it#TS/OST-i 06 permit#TSIOST-55 <br /> Date- Date <br /> - <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG 11 <br /> Tram C ra <br /> gaqMgqflolnej� RQVj8WM9AkALWALt9 Pharmaceuticalll� <br /> Size Qty: lze QtY: Wt Size Qty: 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 /> 6gal- 40 gal 12 gal 20 gal <br /> 8 gal 44 gal 18 gal 38 gal z2 <br /> 12 gal Weight <br /> 18 gal _pAjhpAM Size Qty Weight ELQdMg2qflye-rvL- Qt: <br /> Weight: Item# Description: <br /> p+�ntai Waste <br /> Amalgam:Size QtY Fixer:Si z4_Qty-Developer:Size QtY- <br /> Lead:Size_Qty- Other:Size_Qty <br /> Other:Type: Ci70 <br /> Notes- <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 Mvernment regulations. <br /> rt declare thatthis shipment of wastes free of aza(jousa w'te as defined by the US codeof federal <br /> . <br /> ti r appropliate state nInand i on s <br /> L '7 <br /> U) <br /> Generator(Custorned gnat Date <br /> �am6 of authorized Person(print) <br /> 0 <br /> 0 <br /> Route Driver LDate <br /> Nameof authorized rson(prinQ Signat <br /> Certificate of DestmCdOn signature Date <br /> Incineration Name of authorized person(pdnQ <br /> Certificate of Destruction signature Date <br /> Autodaved Name of authorized person(print) <br />