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0 0 <br /> Barnett Medical Services, Inc 510-429-9911 Ph i Date: 04109/2013 <br /> 30620 San Antonio St 510-429-9914 Fax Manifest M 32760 <br /> 1 Hayward Ca 94544 Customer# 2232 <br /> EPA#CAL000331285 <br /> Transporter ID#4891 <br /> r ierator: <br /> Contact: Safly Solanki WOW 466-2526 <br /> Stockton Hematoloav-Onocolo(w <br /> 2620 N California St,Ste#.3 Frequency of Service weekly I <br /> Stockton,CA 96204 <br /> Pricing $950 a mo. <br /> a Transfer Facility: X D8slinallon Facility: Alternate Transfer Facility a Destinatk�n FaclOty, 0 Alternate Destination Facility <br /> Barnett Medical Services,inc Barnett Medical ServIcesjnc <br /> 30620 San Antonio SI Alternate <br /> Services Photo Wa.-to Recycling Inc Healthcare Environmental <br /> 2385 Arch Rd#200 4800 E.Lincoln Ave 2980 Kern.,r Blvd NC 1420 40th St NW <br /> Hayward CA 94544 Stockton CA 95215 Fowler CA 93625 San Rafae�CA Fargo ND <br /> (510)429-9911 (510)429-9911 659-834-3333 (415)459-180794901 (701)282-737358102 <br /> Permit Permit#TS-87 #TSIOST-106 <br /> ..... - Permit#P NR 122764 Permit#ITF-208 <br /> DatePIC— Ste,-/ 13 <br /> Da <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG 11 <br /> Shar ontalners Regulated Medical <br /> -Waste Pharmaceutical Trach Chem2themin <br /> Size Qty: Size Qty; Wit Size Qty: Wit: Sizel Qty: wt <br /> Up to: 3 gal <br /> 2 gal 20 gal <br /> 8 gal <br /> 4gal 38 gal Z L-�) 9 gal 12 g�l <br /> 6gal 40 gal 12 gal is g#,I - <br /> 8 gal 44gal 20941 <br /> 12 gal 18 gal 38g I <br /> Weight <br /> Size Qty Weight <br /> Pro u <br /> Item It Description: Qt: <br /> Dental Waste., <br /> Amalgam.Size_Qty—Fixer:Size <br /> _Qty_Developer:Size_Qty_ <br /> Lead;Size _Qk_ Other:Slze_Qt_ <br /> `- <br /> other:Type Size Qt <br /> Notes: Hours: M-Thw-870-12:30 11:30-5. Fri B'30-4 <br /> --j <br /> Generator O.Rrtificatlon: I herebycertify that thecontents of this consignmentare fullyd accura,elydescribed above by proper shippingn'ame <br /> and am classified,packed,marked,and labeled,and are in alla'spects in pi opercondition for transport according to <br /> applicable government regulations. <br /> I further dedam that this sNpmentof waste is free of hazarclou sand mer q urywaste as defined by the US ccdeof federal <br /> regu btlons and/or appropriatestate rubs reg dons <br /> Generator(Customer) P <br /> 11-9A <br /> Name of authorized person(prin ature <br /> Route Driver &a�t <br /> 'ut r, ed A�p"ers.,,,T 7 113 <br /> Name of a-Z (prat) ature <br /> Dat <br /> --ertificate of Destrucdon-3-4 kifsp et, —A _ -- � 31 f <br /> Incineration Name of authoked person(print) Date <br /> Cerdfkate of Destrudon Brett Espicha 3/11/2013 <br /> Autoclaved Name of authorized person(print) Signature Date <br />