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Feb, 25, 2016 11 :50AM <br />No, 8337 P. 14/56 <br />Barnett Medical Ses, <br />p(�422qq <br />Inc 510429-9911 Ph • Date, 031 U 1-UIII <br />67904 <br />'�a 30620 San Antonlo <br />qq 4 Fax Manifest #: <br />San Jo kn 2650 <br />Hayward Ca 94544 <br />t'b�t�tlj/ Customer# <br />oP°"' °'iAr1°`'ea'Environmental Health Department DIRECTOR <br />1868 EasCbilh lton AveNe <br />bn, California Qa205-6232 •tRreekl PROGRAM COORDINATORS <br />W: Care CenteSt Y <br />oad <br />Frequency o ervice Robert McClellon, REHS <br />Jeff Carruesco, REHS, RDI <br />q •.......• <br />�5 $4'�� er Month FLAT -RATE Kasey Foley, REHS <br />Website: ov.or9Ud' <br />GiFOR� <br />Adrienne Ellsaesser, REHS <br />Phone: (209) 468-3420 Rodney Estra , REHS <br />38 gal <br />Fax. (209) 464-OT38 Willy Ng, <br />D Tronafer Fooility: 04 Destination Facility-, <br />9arnett Medical Services,lno Barnett Medical Services,lnc <br />o Allemate Transfer Fectlity o Destination Farillty a Allemale Destination Faciii Alternate Transfer Facility <br />Heatthwise SerAms Photo waste Recycling Inc Cunle Bey Energy Daniels Sharpernert <br />$0620 San Antonio St 2385 Arch Rd #200 <br />4900 E. Uncoln Avo 2980 Kamer Blvd TIC 8200 Hawking Point Rd 4144 t5. Yherese Ave <br />Hayward CA 94944 etodaon CA 86216 <br />Fowler CA 93625 San Rarael CA 94901 Baltimore MD 21226 Fresno CA 93725 <br />0((610) 4a9�9911 (510) 429.4911 <br />13"It a TS -07 Permit OTS/OST-106 <br />SSM34-3333 (415)469-007 (4 10) 354-a228 558-634.6252 <br />Permlt #TS -99 PBnnit # PWR 122764 Permit # 2008-WMI.0 30 Permll 11T9JQST e9 <br />Date`yDete <br />Waste Collected: UN 3291 Regulated Medical Waste n.o,s. 6.2 PG II <br />Sharps <br />rontalners Regulated Medical Waste <br />Pharmaceutical <br />Trace Chemotherapy <br />Size <br />Qty: Size Qty: Wt <br />Size Qty: Wt: <br />Size Qty: Wt <br />Up to: <br />3 gal 1 1-0 <br />2 gal <br />20 gal <br />8 gal <br />12 gal <br />4 gal <br />38 gal <br />9 gal <br />18 gal <br />6 gal <br />40 gal 10 <br />12 gal <br />20 gal <br />8'gal 44 gal <br />12 gal <br />A Pathogen: <br />Weight: <br />Dental Waste: <br />AmaIgam:51ze Qty Fixer Size Qty <br />Loa d:Slze Qt other: Size Qt <br />Other: Type _ Size <br />Notes: WjwbWkVf-- , W'. <br />e,q addi tub beyond (B) <br />18 gal 38 gal <br />Size Qty Weight <br />Product Delivered: <br />Item# Description: Qt: <br />Developer: Size Qty <br />Qt <br />Generator Certification: I herebycettlly that the contents of this con5ghmentare fluty and aauratelydescribedabove by propershipping name <br />and are cbssifed,packed, marked, and labeled, and are in all aspects in propercondltlon for transport according to <br />applicable gpuernmettregulelfon5. <br />I furtherdedem thatthls 9hipmentbf waste is free ofhazardousand mercury�a�(e as define a US code offederal <br />regubtions and/or appropriate state tu�r%fiAregulatlons. <br />Generator (Customer) <br />Route Driver <br />ciertlfbcate of Destruction <br />Incineration <br />CertiFicateofDestruc Ion _ <br />Autod aved <br />Received Time Feb, 25. <br />Name of authorized persbli (prhQ <br />Name ofauthorized person (primI �gnature <br />Name of authorized person, (pdno <br />Brett Espicha <br />Name of autho dzed person (print) Signature <br />2016 11:52AM No,1498 <br />Date <br />03/11/2015 <br />Date <br />