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Feb, 25. 2016 11:55AM <br />Barnett Medical Sisros, Inc <br />® 3670 Enterprise Ave <br />Hayward Ca 94545 <br />EPOCAL000404098 <br />TransporterlD#4891 <br />/'�erator: <br />Wins Cbu,,V v Fara Cpanteir -- Lodi <br />321 ? pare= Turner Roa6 <br />Lodi, CA 95240 <br />510-429-9911 PFI <br />510-266-0945 Fax <br />Contact: Pat <br />tarPBhl; <br />Frequency of SA(vIce <br />Pricing 007 <br />0. <br />No, 8337. <br />P. 55/56, <br />Date: <br />lej r.:r,-qj 6 <br />Manifest <br />A Trenafer F$elllty. <br />Customer#�n <br />Fe�(Iry p Altemale DeatinaGon Faclllry <br />'vtilOrr,: ;ZG9) 304-.7�. <br />6hatFamartIOMs <br />Dental Waste: <br />AmaIgam:S12e Qty Fixer, Size Qty Dave Ioper;Slze Qty <br />Lead:Slze Qt- Other;Size Qt <br />Other: Type Size Qt <br />Notes: yours s -a <br />Generator Certification: I herebycertiry that tlt ecaritents of thls consignment ar® fully and avcuretely described above by proper shipping name <br />and are ctassif ed, packed, marked, and labeled, and an? In all aspects In proper co,ndlMoh for transport'according to <br />applicable government regulations, <br />f%rther declare that thl9 shipment of W3M Is frau of hazardous and mercury waste as defined by the US cod eof federal <br />regulations and/or appropriate state Cedes and regulatlons. <br />Generator (Customer) . SrAaclrrL-1 <br />Route Driver <br />Certaftcate of Destruction <br />Inclneration <br />Name Df authorizeh person <br />6 <br />Signature <br />Name 14puthorized person (print) Slgneture <br />Name of authorized person (print) <br />Brett Espicha <br />Certificate of Destruction <br />Autoclaved Name of authorized person (print) Signatur® <br />Received Time Feb,25. 2016 11:52AM No -1498 <br />Date <br />r2• � s- ', <br />to <br />Date <br />12/17/2015 <br />Date <br />A Trenafer F$elllty. <br />Destination Facility. <br />Fe�(Iry p Altemale DeatinaGon Faclllry <br />O Deatirtetan Fac1110�Darilele <br />6hatFamartIOMs <br />Barnett Medical Services, Inc <br />&AhernatvTiensfer <br />iela 8harparnart <br />CurtlaBeyeh0p1gy <br />Photo Waste Recycling Inc <br />3670 EnlerpnaeAve <br />2385 Aron Rd 0200 <br />4 E. Therese Ave <br />. 9200 Hawkins Polni Rd <br />2080 Kamer Blvd 40 <br />Hayward CA 94545 <br />Stockton CA96215 <br />no CA 03725 <br />Baltimore MD 21225 <br />San Rafael CA 84801 <br />(510)429-8011 <br />(510)429-9011 <br />569.834-0262 <br />(410)354.0228 <br />(416)458-8807 <br />Permit#TSIOST-106 <br />? <br />PermitOTS/0ST•66 <br />Permit.#2005WM1-0036 <br />Parmil#PWR1a2764 <br />Dale <br />�Ust <br />Waste Collected: UN 3291 Regulated Medical Wastdn,o.S. 6.2 PG II <br />ZaMS Containers <br />lieeWAW Medical Waft <br />PharmaceulM <br />trace em®therapy <br />Slze Qty: <br />Size Qty: Wt. <br />Size Qty: <br />Wt: Size Qty; <br />Wt <br />Up to: <br />3 gel <br />2gal <br />20 gal <br />8 gal <br />12 gal <br />4 gal <br />38 gal. <br />_� <br />9 ga l <br />18 gal <br />6 gal <br />40 gal <br />12 gal <br />\ 20 ga I <br />8 gal <br />44 gal <br />18 gal <br />38 gal <br />:12 gal <br />Weight <br />mal <br />Size Qty <br />Weight <br />Produla Mlyerad-, <br />Weight: <br />Item d# bescrlptloh: <br />Qt: <br />Dental Waste: <br />AmaIgam:S12e Qty Fixer, Size Qty Dave Ioper;Slze Qty <br />Lead:Slze Qt- Other;Size Qt <br />Other: Type Size Qt <br />Notes: yours s -a <br />Generator Certification: I herebycertiry that tlt ecaritents of thls consignment ar® fully and avcuretely described above by proper shipping name <br />and are ctassif ed, packed, marked, and labeled, and an? In all aspects In proper co,ndlMoh for transport'according to <br />applicable government regulations, <br />f%rther declare that thl9 shipment of W3M Is frau of hazardous and mercury waste as defined by the US cod eof federal <br />regulations and/or appropriate state Cedes and regulatlons. <br />Generator (Customer) . SrAaclrrL-1 <br />Route Driver <br />Certaftcate of Destruction <br />Inclneration <br />Name Df authorizeh person <br />6 <br />Signature <br />Name 14puthorized person (print) Slgneture <br />Name of authorized person (print) <br />Brett Espicha <br />Certificate of Destruction <br />Autoclaved Name of authorized person (print) Signatur® <br />Received Time Feb,25. 2016 11:52AM No -1498 <br />Date <br />r2• � s- ', <br />to <br />Date <br />12/17/2015 <br />Date <br />