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Barnett Medical Services, Inc 510-42-9=9911 Ph Date: 07/01/2015 <br /> 1W3670 Enterprise Ave 510-266-0945 Fax Manifest#: 77348 <br /> Hayward Ca 94545 Customer# 23Z <br /> EPA#CAL000404096 <br /> tor: <br /> ler <br /> Transporter IM891 Contact: Salty Soianki Work:CeN)4%-2D26 <br /> Stockton Hernatolo�OnoColow-Stockl <br /> Frequency weekly <br /> 2626 N Galifomia 5t,Ste#3 Fre G y of Service <br /> Stockton,CA 95204 pricing $950 a W. <br /> O Transfer Facility: IM Destination Facility: f Areemato Transfor Facility O Alternate Destination Facility ❑Destination Fatality <br /> Daniels Sharpsmorl/WS Barnett Medical Services,lnc fl b%i'.2 Sherpsmart Curtis Bay Energy Photo Waste Recycling Inc <br /> 3670 Enterprise Ave 2385 Arch Rd#2Q0 4144 E.Therese Ave 3200 Hawkins Point Rd 2980 Kerner Blvd#C <br /> Hayward CA 94545 Stockton CA 95215 Fresno CA 93725 Baklmere MD 21226 San Rafael CA 94901 <br /> (510)429-9911 (610)429-9911 559-834.8252 (410)W-3228 (416)45948807 <br /> Permit#TWOST-106 Permit#TSIOST-55 Permit#2005-WMI-0036 Pem*1V PWR 122764 <br /> Date- <br /> Waste <br /> ate Waste Collected: UN 3291 Regulated Medical Waste n.os.6.2 PG II <br /> Steps Contalners Regulated Medical Waste Pharmaceutical Trace Chemotherapy <br /> Size Qty: Size Qty: Wt Size Qty: Wt: Size Qty: Wt <br /> Up to: 3 gal <br /> 2 gal 20 gal 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 �� f <br /> 12 gal Weight <br /> ;al -Size Qty Weight Product Dkellyered: <br /> Might: Ratho Item# Description: Qt: <br /> Dente!Wast <br /> Amalgam:Slze QtyFixer:Slze Qty Developer:Size Qty <br /> Lead:Size - Qt Other:Size Qt <br /> Other:Type Size t <br /> Motes: n <br /> Generator Certification: I hereby certify that the contents of this consignment are fully and accurately described above by proper shipping name <br /> and are classified,packed,marked,and labeled,and are In all aspects in proper condition for transport according to <br /> applicable government regulations. <br /> I further declare that this shipment of waste Is free of hazer s nd r ry waste of ed the US codeof federal <br /> regular ns and/ora proprlate state rules aqd <br /> regWati <br /> j. <br /> Generat0.. .. <br /> Na ofaur Izedperson, a Date <br /> Route Driver 6" t Z-. <br /> Name of alit rized person(print) Slgr)ature Date <br /> CertifiC-ate of Destruction <br /> Incineration Name of authorize&person(print) I ature Data <br /> Certificate of Destruction Brett Esplcha 1((�}14/� <br /> Autodaved Name of authorized person(print) Signature Date <br />