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0 . 0 <br /> Barnett Medical Services, Inc 510-429-9911 Ph Date: 01115/20-13 <br /> A Tko t� Manifest M 27941 <br /> 30620 San Antonio St 510-429-9914 Fax <br /> Hayward Ca 94544 Customerff 2232 <br /> EPA#CAL000331285 <br /> r"qnerator: Transporter lD#4891 Contact Sally Solanki WOTK: (9)456-2526 <br /> Stockton Hem atolow-Onocol0clY Frequency of Service weekly <br /> 2626 N California St,Ste#3 <br /> Stockton,CA 95204 Pricing $960 a Mo. <br /> n Transfer Facility: X Destination Facility: j),Alternate Transfer Facility r3 Deslination Facilityornate Destination Facility <br /> Alternate <br /> Environmen <br /> Barnett Medical Services,ine Barnett Medical Services.1ne F Daniels Sharpsmart Photo Waste Recycling Inc PlZa tat <br /> 30620 San Antonio St 2385 Arch Rd#200 4144 E,Therese Ave 2980 Kerner Blvd#C 11420 401h St NW <br /> Hayward CA 94 54 4 Stockton CA 95215 Fresno CA 93725 San Rafael CA 94901 Fargo No 58102 <br /> (510)429-9911 (510)429-9911 559-834-6252 (415)459-8807 (701)282-7373 <br /> Permit#TS 87 PerlTtOST-110"5 6 Permit#TS/08T-65 Permit#PWR 122764 Permit#ITF-208 <br /> Date —Date4j 13 <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG 11 <br /> Sharps Containers- Regulated Medical Waste Pharmaceutical Trace Chemotherap <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 /> 4gal 38 gal 9 gal 18 gal <br /> 6gal 40 gal 12 gal 20 gal <br /> 8 gal 44 gal 18 gal 38 gal <br /> 12 gal Weight <br /> j- --41 Pathogen: Size Qty Weight Product Delivered: <br /> Vv-eght: Item# Description: Qt: <br /> Dental Waste: <br /> Amalgam:Size Qty_Fixer-Size—Qty_Developer:Size Qty <br /> — <br /> Lead:Size Qty Other:Size_Qty <br /> Other:Type: Size,--Qty <br /> Notes- Hours: M-Th 6:12:30 <br /> Generator Certification: I hereby certify that the contents ofthis con strimentare fully and accurately described above by proper shipping name <br /> and are chssif led,packed,marked,and labeled,and are in all aspects in proper conclitlon'for transport according to <br /> applicable gDvernmen t regulations. <br /> Ifurtherdeclare thatthis shipment of wasteisfree opri7jr4ousand mercury waste as defined by the US codeof federal <br /> regulations and/or appropriatestate rules and gj idons. <br /> Generator(Customer) <br /> Name of authorized person 40 tore Date <br /> Route Driver -MWAf-2---- — --�) --—————— <br /> Name of authorize person(print) 99 Date <br /> K?� C1/41ILPI <br /> -Artiflcate of Destruction <br /> t <br /> tu Date <br /> Incineration Name of authorized person(print) 1/16/20i*13 <br /> Brett Espicha <br /> Certificate of Destruction — ————-————————————————— <br /> Autodaved Name of authodzed person(print) Signature Date <br />