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- <br /> A92ho-', Barnett Medical Services, Inc 510-429-9911 Ph Date: 013 <br /> I Pjk 30620 San Antonio St 510-429-9914 Fax -Manifest#: 3A7GI <br /> 0 <br /> Hayward Ca 94544 Customer# <br /> CV-To(\ Frequency of Service wie"Y <br /> '2AVO-b M, Pricing <br /> a Transfer Facility: X Desfination Facility: Alternate Transfer Facility n Destinati:)n Facility (3 Alternate Destination Facility <br /> Barnett Medical Services,lnc Barnett Medical SepAces,lnc 'Danlels Sharpsmart Photo Wi sle Recycling Inc Healthcare Environmental <br /> 30620 San Antonio St <br /> Ker ier Blvd#C 1420 40th St NW <br /> _—Arch—_'-_ ,-~~ ...~~'~- -'--_ <br /> Hayward CA 94544 Stockton CA 95215 Fresno CA 93725 San Rafe,I CA 94901 Fargo ND 58102 <br /> (510)429-9911 (510)429-9911 559-834-6262 (415)45E.8807 (7011)282-7373 <br /> Permit#T9-87 Perrnit#TS/OST-106 Permit#TS/OST­55 Permit# 'WR 122764 Permit#ITF-208 <br /> Date Date <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG 11 <br /> ` <br /> Size Qty: Size Qty: Wt Size Qty: Siz Qty: Wt <br /> Up to: 3 gal <br /> 2 gal 20 gal 8 gal 12 gal <br /> 4 gal 38gal 9 gal 18 gal <br /> 6 gal 40gal 12 gal 20 gal <br /> 8 gal 44gal 18 gal 38 7al <br /> 12 gal Weight <br /> II RalhoLen.Size Qty Weight ProductlDell ered; <br /> Amalgam:Size_Qty Fixer:Size. Qty_Developer:Sl ze_Qty_ <br /> Lead:Size. Qty_ Other:Size Qty_ <br /> Other:Type: SI ze—Qtx <br /> Generator Certification: I herebycertify that the contents of this consli;nmentare fully and accuiatelVdescdbed above by proper shipping name <br /> andare classif ied,packed,marked,and labeled,and are In allaspects In proper condition for transport according to <br /> applicable goveramentregulations. <br /> I further d edare that thIs shipment of waste Is free of ha sand wa K'as defined by the US codeof federal <br /> r lations and/or appropriate state rules and regulad S. <br /> Generator(Customer) T; <br /> ,n�6 <br /> Name of authorized person(prht) <br /> ' \ — -- ognGlure­''- Date <br /> ^ <br /> � <br /> Route Driver <br /> "-CentiflwmtemVDestruction <br /> Incineration wamamauthorized person(vmnh tu Date <br /> Bre1tEspichm 3/17/2013 - <br /> Certificate wYDmot*uotimm ' <br /> Autoclaved Name"/""muxzemperson(vnoo y:w`v,o Date ^ <br /> � . <br />