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Regulated Medical Waste MANIFEST# 4146499 CODE AREA UN3291,Regulated Medical Waste,n.o.s.,6.2,PGII BAR= MEDICAL SERVICES,INC 60rex-,-Jat'ejae,%a4"r 0.i PassiOa COMPANY NAME TELEPHONE NUMBER UPTOWN INK (209)466-1200 ADDRESS O 3228 Pacific Ave Stockton,CA 95337 I certify that the information provided is true and correct,and that the generated materials are properly classified,described, Z packaged,labeled/placarded;and are in proper condition for transportation according to the applicable regulations of the LU U.S.Department of Transportation. Cesar ce 05-04-2022 1:04 PM NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE NAME(S)OF PERSONS COLLECTING,TRANSPORTING OR UNLOADING WASTE INITIALS REGISTRATION NUMBER Miguel Corona MC 6183 COMPANY NAME TELEPHONE NUMBER w Barnett Medical Services (800)748-1803 � ADDRESS DATE MEDICAL WASTE COLLECTED 0 P.O.Box 4436 Hayward,CA 94540 05-04-2022 1:04 PM Z 20 Gal RMW Q acont. wt.p acont. wt.a pcont. wtp pcont. acont. wLp 1 1 30 F- I certify that the information provided above is true and correct and that only untreated medical wastes are contained in this load.I am aware that Qfalsification of this manifest may result in forfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. Miguel Corona 05-04-2022 1:04 PM NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE TRANSF=R STATION: NAME REGISTRATION NUMBER N REGISTRATION NUMBER NAME(S)OF PERSONS COLLECTING,TRANSPORTING OR UNLOADING WASTE NITIALS cc LU COMPANY NAME TELEPHONE NUMBER O a Z cc ADDRESS DATE MEDICAL WASTE COLLECTED cc F- Q icons. wt.aactin[. W, Ncon[. wLa pcant. wf.a Mcont. Wt Q I certify that the information provided above is true and correct and that only untreated medical wastes are contained in this load.I am aware that Ln cc falsificztion of this manifest may result in forfeiture of my transporter's registration and/or the privilege of utilizing State-authorized facilities. LU LL N Z Q F- NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE COMPANY NAME TELEPHONE NUMBER ADDRESS r F- PERMIT NUMBER DATE WASTE WAS DEPOSITED/UNLOADED TOTAL WEIGHT DEPOSITED/UNLOADED V Q I— DISCREPANCY INDICATION SPACE Z LU LU I certify that I have been authorized to accept untreated medical wastes and that I have received the above indicated wastes in accordance with the requirements outlined in that authorization. NAME OF COMPANY REPRESENTATIVE(Print) SIGNATURE OF REPRESENTATIVE DATE In cast of emergency,call( 925 321-5938 (24-hr company or other emergency response group telephone)