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Feb, 25. 2016 11:50AM No. 8337P, 17/56 <br />Barnett Medical Se s, Inc "510429-9911 Ph Date: 031. 0P .-I IN <br />30620 San Antoniou 510-4R-9914 Fax• Manifest #: 70997 <br />(� Hayward Ca 94544 San Joaquin unty Customer# 2560 <br />P.Qui <br />!yfa ftt1D 989 Environmental Health Department DIRECTOR <br />Lindajii e �37m, <br />i at,�_ . :i 1��8R�6��8EasMetaeikton Ave de <br />W, Carp Celltsgt`OE.`Fin, Cplifornia NO -6232 Weekly PROGRAM COORDINATORS <br />• :P 08d regtlency O ell Oe • Robert McClellon, REHS <br />i � yer Month FLAT-FdFl � Jeff Carruesco, REHS, RDI <br />C0 Website: IZflla�nt%�9 " ov.orge Kasey Foley, REHS <br />��/FORa Adrienne Ellsaesser, REHS <br />Phone: (209) 468-3420 Rodney Estrada, REHS <br />r*ax- (209) 464-0131s Willy Ng,1;44 <br />D Transfer f'selty: a Destination Facility: a Alternate Transfer Faolllty d Dee,tlna9on Fricillry Q Altemala Destination Falternate TratimW Facility <br />Uatnert Medloal Servioaa,lno 9amen Medical Servicas,inc Heathwlse ServieaB Photo WASle P,00VCllhg Ino Qur11s gay energy niels shatpernart <br />30620 San Antonio SL 2306 Amh Rd #200 4900 E Uncol n Ave 2980 Kerner Blyd #G 3200 Hawkins Point Rd 5. Therese Ave <br />Hayward CA 94544 Stockton CA -95218 Fawfor CA 93626 San Rafael CA 94901 Baltimore MD 2122a Freano CA 93725 <br />(610) 429-9911 (510) 429-9911 559-834-3333 (416) 459-%&07 (410) 854-3226 559.834-6262 <br />rm110TS-67 Par f1.OTSIOST-106 PermitIITS-69 Permit 6PWR122784 Permit#2005-WMI.0030 permit*YS10ST-65 <br />Dalo DOte�%/ <br />Waste Collected: UN 3291 Regulated Medical Waste n.o.s. 6.2 PG II <br />Sharps Containers Regulated Medical Waste_ Pharmaceutkal Trace Chemotherapy <br />Size Qty; Size Qty: Wt Size Qty: Wt: Size Qty: Wt <br />Up to: 3 gal `Z- 2-p <br />2 gal 20 gal 8 gal 12 gal <br />4 gal 38 gal 9 gal 18 gal <br />6 gal 40 gal 0 12 gal 20 gal <br />8 gal 44 gal 18 gal 38 gal <br />12gal Slze Qty Weight <br />mal Pathogen: Product Delivered: <br />Weight: Item # Description: Qt: <br />Dental Waste: <br />Amatgatn' Size Qty Fixer. Slzq Qty Developer, Size_"_ <br />Lead; Size Qt Other Size Qt <br />Other: Type Size Qt <br />o <br />Nates: ea adell tufa bL-yQnd (0) <br />Generator certification: <br />Generator (Customer) <br />Route Driver <br />Certificate of nestrucdon <br />Incineration <br />I hereby certify that d%acontents ofthlo con signmEnt aro ffilly and accuratelydesctibed aboee by proper shlpppIng name <br />and are chssifitd,packed, marked, and labeled, and ars In all aspects In proper condition for transportaccording to <br />applimble q3uernrnEnt regulations. <br />I furtherdedere thatthi9 ohlpmentofwam Isfree of hazardausand meralrywaste as defined by thr u5 oodeofWeral <br />regulatlons and/or approprfatesrate rulat and regklaoans. <br />Name of authorised person <br />5rgnature <br />Name nuthorized person (prh0 Qsnature <br />Name ofauthorlred parson (pdnO <br />Brett Espicha <br />Dote <br />Date <br />04/01/2015 <br />Certificate of Destruction -- — -- — <br />Autoclaved Name ofauthoazed person (print) S)6R$ture Date <br />Received Time Feb,25, 2016 11:52AM No -1498 <br />