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Barnett Medical Services, Inc 510-429-9911 Ph Date: 07/02/2013 <br /> 30620 San Antonio St 510-429-9914 Fax Manifest#* 37511 <br /> I fo,k nja Hayward Ca 94544 Customer# 2232 <br /> QF EPWAI-0003311285 <br /> Transporter ID#48911 <br /> ierator: . Contact: Sally Solanki WOR:(M)466-2626 <br /> Stockton Hematolow-Onocollow Frequency of Service weekly <br /> 2620 N Caldomia St.Ste#3 <br /> Stockton,CA 95204 Pricing $950 a Mo. <br /> n Transfer Facility: X Destination Facility: o Alternate Transfer Facility n Destination Facility bit Alternate Destination Facillty <br /> Barnett Medical Services,lnc Barnett Medical Services,inc Haallhwlsa Services Photo VVaste Recycling Inc ' "Healthcare Environmental <br /> 30620 San Antonio St 2385 Arch Rd#200 4800 E.Lincoln Ave 2980 Kerner Blvd#C 1420 40th St NW <br /> Hayward CA 94544 Stockton CA 95216 Fowler CA 93625 Son Rafael CA 04901 Fargo ND 58102 <br /> (510)429-9911 (610)429-9911 559-834.3333 (415)459-6807 (701)282-7373 <br /> Permit#TS-87 Permit#TS/OST-1106 Permit#FYWR 122764 Permit#ITF-208 <br /> Date Data� <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PIS III <br /> Sharns Containers Regulated Medical Waste Pharmaceutical Trage Chemotherapy <br /> Size Qty: Size Qty: Wit Size Qty: Wt: Size Qty: Wt <br /> Up to: 3 gal <br /> 2gal 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 44gal 18 gal 38 gal c2. <br /> 12 gal Weight <br /> ,al Size Qty Weight Product Delivered: <br /> Weight: Pathogen: Item# Description: Qt: <br /> Dental Waste: <br /> Ama I gam:Size_Qty_Fixen Size_Qty_Developer-,Size_City <br /> Lead:Size—Qt Other:Size Qt <br /> Other:Type Size_Qt__ <br /> Notes: 1;30-4 <br /> Generator Certification: I herebycertify that thecontents of this consignment are fully and accurately described above by proper shipping name <br /> applicable <br /> are classified,packed,marked,and labeled,and are in allaspects in propercondition for transport according to <br /> government regulations. <br /> I furtherdeclare that this shipment of waste,Is free of Y haz�&Utynd/n ercury waste as r1ned by the US cocleoffederal/ <br /> cegulatiGns and/or aplaropflale,late rulsandregula" <br /> Generatcammow A/h //x <br /> I <br /> Date"10 mono <br /> M" —C� — <br /> Route Driver <br /> Name of authpAzed person(prht) natur D <br /> /,a <br /> r, at ,. <br /> T 16 <br /> --Certificate of Destruction <br /> Incineration N ame of authorized person(pdnQ turDate <br /> Brett Espicha <br /> 7/3/2013 <br /> Certificate of Destruction <br /> Autoclaved Name of authodzed person(print) Signature Date <br />