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Barnett Medical Services, Inc 510-429-9911 Ph Date: 01/29/2013 <br /> IOU,ma qi� 30620 San Antonio St 510-429-9914 Fax Manifest M 27943 <br /> Hayward Ca 94544 CListomer# 2232 <br /> EPA4CAL000331285 <br /> rlerator: Transporter 1D#4891 • <br /> Contact: Sally Solanki WOW(M)46&2626 <br /> Stockton Hem atolow-Onocol ociv Frequency of Service weekly <br /> 2626 N California St.Ste#3 <br /> Stockton.,CA 062114 Pricing $950 a m. <br /> a Transfer Facility: X Destination Facility: fh"Altemate Transfer Facility o Destination Facility <br /> Barnett Medical Services,ine Barnett Medical Services,inc ,Alternate Destination Facility <br /> Daniels Sharpsmart Photo Waste Recycling Inc Healthcare Environmental <br /> 30620 San Antonio St 2385 Arch Rd#200 4144 E.Therese Ave 2980 Kamer Blvd#C 1420 dOIh 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)4598807 (701)282-7373 <br /> Permit#TS-87 Permy4#XSIOST-106 <br /> 111 1- j �ermit#TS/4ST-55 Permit 4 PWR 1122764 Permit#ITF-208 <br /> Date— Date <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG 11 <br /> SharRs Containers Reltulated Medical Waste <br /> Pharmaceutical Trace Chemotherapy <br /> Size Qty: Size Qty.- Wt Size Qty: Size Qty: Wt <br /> Up to: 3 gal <br /> 2 gal 20 gal <br /> 1 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 /> 1 11 Pathogen: Size Qty Weight Product Delivered: <br /> Weight: Item 9 Description: Qt: <br /> gental Waste: <br /> Amalgam:Size_Qty_Fixer:Size Qty Developer:Size Qty_ <br /> Lead:size_Qty_ Other:Slze Qty_ <br /> Other:Type: Size 9--Qty <br /> — <br /> Notes: Hours: M-Th 8:30-12.30 11:3D-5.Fri 1:304 <br /> Generator Certiflcatlon: I hereby certify that th e c onte nts of this oDn sig nment a re fu illy and ac cura tely desc d bed a bo ve by proper shipping name <br /> and are ch SO ied,p acked,marked,and labeled,and are in all aspects I n proper condition for transport according to <br /> applicable governmentregWations. <br /> I furthercleclare that this shipmentof waste is free 9walardousand mercurywaste as defined by the US codeoffederal <br /> regulations and or appropriate state rules and re-RO-alio <br /> S. <br /> Generator(Customer) <br /> Name of authorize t'&on(pf/1) )Fenanature Dat <br /> Route Driver14 A- <br /> Na';r-Arauth6rhzeTp;r--FPI-W) - Signature V Dat <br /> W <br /> —Certificate of Destruction 9cc 49 <br /> --————————— <br /> Incineration Name of author zed person(pdnt) Date <br /> Certificate of Destruction Brett Espicha 1/31/2012 <br /> Autodaved Name of authorized person(print) Signature Date <br />