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Feb, 25. 2016 11; 53AM <br />maBarnett Medical Se Oes, Inc <br />3670 Enterprise Ave <br />Hayward Ca 94545 <br />EPA#CAL000404096 <br />Transporter ID#4891 <br />Aerator: <br />Wine i ouutry Care Center - Lodi <br />-Rs 9 West Tamer Road <br />Logi, CA 95240 <br />510429-9911 Ph <br />510-266-0945 Fax <br />Contact: Pat <br />No, 8337 P. 39/56 <br />Date: 99/01/2015 <br />Manifest #: 80063 <br />Customer# 2560 <br />Frequency of Service weekly <br />Pricing $45,6 per Month PLAT FATE <br />WPM RM} 934.$76 -Sr <br />O Transfer f ejolllty; <br />21 bsstinafion Fedll y; <br />0 Alternate Transfer Facility <br />O Alternate D®itlnatlon P9ollly <br />Q DeaOnatlon Facility <br />Daniels 5harpsmert/BMS <br />Barnett Medical Service%lnc <br />Danlele Shorpsmart <br />Curtis Bey Fnergy <br />Photo Waa(e Recycling Inc <br />3670 Enterprise Ave <br />2385 Arch Rd #200 <br />4144 E. Thereae Ave <br />3200 Hawkins Point Rd <br />2960 Komar Blvd #c <br />Hayward CA 94545 <br />Stockton CA 86216 <br />Fresno CA 93726 <br />Bel(Imora M13 21228 <br />San Rafael CA 94801 <br />(510) 42o-9911 <br />(510) 429.9911 <br />559-9346252 <br />(410) 364.3228 <br />(415) 469-6807 <br />Date(�fl1L.t— <br />Permit #TSIOST-106 <br />PermftAT®IOST--55 <br />Permit02005-WMI-0030 <br />Permit # PWR 122764 <br />Waste Collected: UN 9291 Regulated Medical Waste n.o.s. 6.2 PG II <br />Shams Containers <br />Regulated Medical Waste <br />Pharmaceutical <br />Trace Chomotherapy <br />Size Qty; <br />Size Qty: Wt <br />Size Qt�: Wt. <br />Size <br />Qty: Wt <br />Up to: <br />3 gal <br />2 gal <br />20 gal <br />8 gal <br />12 gal <br />4gal <br />38 gal <br />9 gal <br />18 gal <br />6 gal <br />40 gal <br />12 gal <br />20 gal <br />—� <br />8 gal <br />4¢ ga I <br />18 gal <br />38 gal <br />12 &dl <br />Weight <br />mal <br />Size Qty Weight <br />product delivered; <br />Weight: <br />Pathat?en: <br />Item <br />Description: Qt. <br />Dental Waste., <br />Amalgam; Size Qty Fixer:512e Qty Developer: Size Qty <br />Lead. Size Qt Other; 51ze Qt <br />Other: Type Size Qt <br />Notes: up10(6)40'5 Per FvcO.�- 275 ©urs: M <br />ea addl tub. beyond (6) <br />Generator Certification; I hereby certify that the contents of this consignment are fully and accurately described above by proper shipping name <br />and are classified, packed, marked, alld labelad, and are In all aspects in proper condition fvr tmnsport according to <br />applicable government regulations. <br />( further declare chit this shipment of waste is free of hazardous and rnercrry Walla as defined by thecod s of federal <br />regulations and/or approprlate state rules and regulations. <br />generator (Customer) �� �G1Q17.NtA VYt(,1/Aillidy! lly�--' qit��11' <br />Marne of authorized <br />Route Driver <br />Certificate of Destruction <br />Incineration <br />Certificate of Destruction <br />Autod aved <br />Received Time Feb, 25 <br />Name ofauthortze person (print) <br />Name of authorized person (print) <br />Brett Espicha <br />Name of aufhorized person (print) <br />2016 11.52AM No, 1498 <br />Signature <br />Da <br />� - fos <br />Date <br />Date <br />09/03/20.5 <br />Date <br />