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Barnett Medical Services, Inc 510429-9911 Ph Date: 01/08/2013 <br /> 30620 San Antonio St 510-429-9914 Fax Manifest #; 27 <br /> Hayward Ca 94544 Customer# 2232 <br /> . EPA#CAL000331285 <br /> Transporter ID#4891 <br /> aerator: Contact: Sally Solanki Work:902)455-2626 <br /> Stockton Hematolow-til ocoloov Frequency of Service weekly <br /> 2628 N California St,Ste#3 <br /> Stockton,CA 95204 Pricing $980 a mo. <br /> o Transfer Facility: X Destination Facility: Alternate Transfer Facility o Destination Facility }pr�Alternate Destination Facility <br /> Barnett Medical Services,lne Barnett Medical Services,lne Daniels Sharpsmart Photo Waste Recycling Inc �' Healthcare Environmental <br /> 30620 San Antonio St 2385 Arch Rd#200 4144 E.Therese Ave 2980 Kerner Blvd#C 1420 40th St NW <br /> Hayward CA 94544 Stockton CA 95215 Fresno CA 93725 San Rafael CA 94901 Fargo ND 58102 <br /> (510)429.9911 (510)429-9911 559-834-6252 (415)459-8807 (701)282-7373 <br /> Permit#TS-87 Perm9(,—Date <br /> TSIOST•106 Permit#TSIOST 55 Permit#PWR 122764 Permit#1TF•208 <br /> Date eb' 3 <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG II <br /> Shares Containers Regulated Medical Waste Pharmaceutical Tcace Chemotheranv <br /> Size Qty: Size 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 /> 6 gal 40 gal 12 gal 20 gal <br /> 8 gal 44 gal 18 gal 38 gal <br /> 12 gal Weight <br /> 11 Pathogen: Size Qty Weight Product Delivered: <br /> W-eight• Item# Description: Qt: <br /> Dental Waste., <br /> Amalgam:Size Qty Fixer:Size Qty Developer:Size Qty <br /> Lead:Size Qty Other:Size Qty <br /> Other:T e: Size Qty <br /> Notes: ours: Fri E:30-4 <br /> Generator Certification: I herebycertlfy that thecontents of this consignment are fully and accurately described atone by proper shipping name <br /> and are cbssifLed,packed,marked,and labeled,and are in all aspects in proper condition for transport according to <br /> applicable governmen t regulations. <br /> I furtherdedare thatthis shlpmentofwaste is frehazardousand mercer waste as defined by the US codeof federal <br /> re@j btlons and/or appropriate state rules an re la ons. <br /> Generator(Customer) (:E <br /> Name of authorized person( rnt} Nignature QDate <br /> Route Driver ^/ --- <br /> Name of author zed person(prh) 5g cure Date / <br /> t:ertifk:ate of Destruction 5-c Lir 15%', — <br /> Incineration Name of authorized person(pdnt) �j�""Rater — ' 1�10�2® ,s <br /> Date <br /> Brett Espicha l <br /> Certificate of Destruction ------ ___ _ --- --------__._---- — <br /> Autodaved Name of authorized person(print) — �— Signature Date <br />