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0 0 <br /> ,A Barnett Medical Services, Inc 510-429-9911 Ph Date: 07/16/2013 <br /> k 30620 San Antonio St Manifest - 37513 <br /> 4W'k 5 510-429-9914 Fax #. <br /> Hayward Ca 94544 Customer# 2232 <br /> EPA#CAL000331285 <br /> -ierator: Transporter. ID#4891 Contact: Salty Sclank! Work:(2m)468-21526 <br /> Stockton Hematoloqy-Onocolo(W weekly <br /> 2020 N California St.Ste#3 Frequency of Service <br /> Stockton,CA 95204 Pricing $050 a mo. <br /> t3 Transfer Facility: X Destinallon Facility: o Alternate Transfer Facility n Destination Facility Alternate Desitnallon Facility <br /> Barnett Medical ServIces,Inc Barnett Medical Services.ine Healthwise Services Photo Waste Recycling Inc Healthcare Environmental <br /> 30620 San Antonio St 2385 Arch Rd#200 4600 E,Lincoln Ave 2960 Kerner Blvd#C. 1420 40th S1 NW <br /> Hayward CA 94544 Stockton CA 95215 Fowler CA 93625 San Rafael CA 94901 Fargo ND 58102 <br /> (510)429.9911 (510)429-9911 559-834-3333 (415)469-8807 (701)282-7373 <br /> Permit#TS-87 Permit#TSIOST-106 Permit#PWR 122764 Permit#ITF-208 <br /> Date Date 4 <br /> 0( –7 A <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG 11 <br /> Sharps Containers Regulated Medical Wa•ste Pharmaceutical Trate Chemotherapy <br /> Size Qty: Size Qty: Wt Size Qty: Wt: Size Qty: Wt <br /> Up to: 3 gal <br /> 2 gal 20gal 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 /> ,al Size Qty Weight Product Delivered: <br /> weight: Pathouen: Item# Description: Qt: <br /> Dental Waste: <br /> Amalgam:Size—Qty_Fixer:Size_Qty Developer:Size_Qty_ <br /> Lead:Size_Qt_ Other:Size_Qt <br /> Other:Type SizeQt . . . <br /> Notes: nauf b. 4:313-41 <br /> Generator Certification: I herebycertify that thecontents of this con5Vnmentare fully and accuril'telyclescribed above by proper shipping name <br /> and are classif Ied,packed,marked, labeled,and are in all aspects In propercondition for transport according to <br /> applicable government regula,on . <br /> I further d eclare that this shipment of waste is free of haz usai mercurywaste defined by the.US codeoffederal <br /> re(platfons and/or appropriate state rules and regula S. <br /> Generator(Customer) <br /> A <br /> Name of authorized person(p(• gnature <br /> Date <br /> Route Driver ----7—/V8 <br /> Name of authotWed person(print) A,4gnatur Date <br /> Certificate <br /> .-Certificate of Destruction <br /> CA <br /> Incineration Name of authoriled person(print) g to Date <br /> Brett Espicha 7/18/2013 <br /> Certificate of Destruction <br /> Autodaved Name ofauthorized person 1printl Signature Date <br />