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Feb, 25. 2016 11:51AM - <br />No, 8337 P. 27/56 <br />Barnett Medlcal Se s, Inc <br />510=429-9911 <br />Ph bate: 06/uy1MII 5 <br />�a 3670 EnterpHse Ave <br />510-266-0945 <br />Fax Manifest #: 73117 <br />Hayward Ce 04545 <br />Qty: Wt:� <br />Customer# 2360 <br />5PA#CAL000404090 <br />3 gal <br />Transporter IDW91 <br />ierator: <br />Contact: Pat <br />Work: (,) BU -31780 <br />Wine Claurit.ry Care Corder'- Lobi <br />8 gal <br />weekly <br />321 WestTu mer Road <br />Frequency of Service <br />38 gal <br />Lodi. GA 0,240 <br />Pricing $4:56 po-r Month FLAT -RATE <br />O Trarwor Faolligri ✓sfl Destination Padl0j: <br />A�rneto Transfer FeWity <br />Cl Alternate De4tinatlon Faolllty 0 DeAlnetion Facility <br />Daniels Sharpsmart/9M8 Datnett Medical Service®,Inc <br />1)anlely Sharpsm®rt <br />CUrlis Bay Energy Photo Weeta Recycling Inc <br />3670 Entarpriae Ave 2389Aroh Rd 000 <br />4144 E. Theresa Ave <br />3200,Hawktna Point Rd 2880 Kerner Blvd 00 <br />Hayward CA 94545 Stoddan CA 96216 <br />Freano CA.93725 <br />Baltimore MD 21226 • San Rafael CA 9001 <br />(610) 429-9911 (5 10) 429.9311 <br />Permit ft TS/OST.-106 <br />639,434-6262 <br />Permit OTS/10ST-89 <br />(41 U) 354-3220 (416) 459-860T <br />Parmil 4 200$-WMI-0036 ParmlIVIRWR 122764 <br />Product Delivered: <br />Weight: <br />Date k - —Dat r <br />Item # Description: Qt: <br />Waste Collected: UN 3291 Regulated Medical Waste h.o.s. 6.2 PG li <br />SharRE CQntainers <br />Regulated Medlcal <br />Waste. Pharmaceutical <br />Trace ChemotbMppy <br />Size Qty: <br />Site Qty, <br />Wt Size <br />Qty: Wt:� <br />ize Qty: Wt <br />Up to; <br />3 gal <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 />8 gal <br />AO gal �� <br />44 gal <br />12 gsl <br />18 gal <br />20 gal <br />38 gaI <br />12001 <br />Weight <br />Size <br />Qty Weight <br />Product Delivered: <br />Weight: <br />n; <br />Item # Description: Qt: <br />Dental Waste., <br />Amalgam:Slre Qty Fixer: Size Qty <br />Lead: Slze ' Qt— Other: Size Qt <br />Other: Tvpe Size <br />Notes: <br />as addl tub beyoriid (6) <br />Developer: Size Qty <br />Generator Cwtifleation; I herebycBMlfy that the contents of this conalgnmant are fully and accurately described above by propgr shipping name <br />end are classified, packed, marked, and labeled, and are In all 56pects in proper condition for transport according to <br />a pplicablegovernmentregul ons, <br />1 forth declare that dila s mast of waste Is free of hazardous and lnercuryws5te tie defined by tie US Cod a of federal <br />re ons and/or prix ate stet® rubs and reguladpns- <br />Gen erator (Customer) <br />Name afauthorized person,( Int) SignatuDO Date <br />Route Driver <br />Certificate of Destruction <br />Incineration <br />Name of Ii[Ahorized person (print) Signat fte <br />Name of authorized person (print) tur Date <br />Brett Espicha 06/10/2015 <br />Cortificdte of Destruction <br />Autocleved Name of authorized person (print) <br />Received Time Feb,25, 2016 11:52AM No -1498 <br />Signature <br />Date <br />