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BARNISFY-MEDICAL SORVICES <br /> 30620 San Antonio St Hayward, CA 94544 <br /> Office: 510-429-9911 Fax: 510-429-9914 <br /> STATE OF CALIFORNIA TRANSPORTER LICENSE#4891 EPA# CAL000159569 <br /> STATE OF CALIFORNIA MEDICAL WASTE TRACKING FORM <br /> TRACKING # CUSTOMER 360 # 5/�7�1 <br /> 'S <br /> MEDICAL WASTE GENERATOR DATE PHONE <br /> SAtelfitu, DiWysis--T6—,,D-y 96"2 _2 B`6 1 Worr'. 209) 02'52-4899 <br /> I 5f W'. '.?,ani nE W 5C <br /> rI , j <br /> Contact: <br /> Johr, <br /> Notes: 419 palion coniainers, (6-61) <br /> Pricing: <br /> Hou-s <br /> SHARPS COLLECTORS <br /> Up to: 2 gal. 4 gal. _6 gal._8 gal._12 gal 18 galOtherApprox. weight <br /> BIOHAZARDOUS WASTE (Red Bags) Up to: 10 gal._20 gal Approx. weight <br /> 0 <br /> PATHOGEN: Size:_ Quantity_ Approx. weight <br /> CHEMO: Size: Quantity_ Approx. weight <br /> PHARMACEUTICAL WASTE Up to: 3 gals-- L 9 gals l 18 gal Approx weight- 7 <br /> _ <br /> DENTAL: Amalgam_ Amalgam Filter Fixer/Developer Lead Other <br /> FREQUENCY OF SERVICE <br /> 20 gal 38 gal 40 gal 41, gal�,,, Approx Weight <br /> I certify that the containerized medical waste listed above is properly packaged and labeled and is not leaking at <br /> the time of removal from this facility. <br /> Signature'- OVNEfR-T TRANSPORTER <br /> [X]DANIELS SHARPSMART [X]HEALTHCARE ENVIRONMENTAL <br /> 4144 E.THERESE AVE 1420 40TIl ST MW <br /> FRESNO,CA 93725 FARGO ND 58102 <br /> TREATMENT PER-MIT#TS/OST-55 INCINERATION PERMIT#ITF-208 <br />