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Feb -25-2016 11:49AMNo. 8337 P. 6/56 <br />A!4L,t4�kuarnett medical Se s, Inc 510-429-9911 29,9911 Ph Dare: ®�, � -ufftu rJ <br />30620 San Antonio t 510-429,9914 fax Manifest #: 6YO72 <br />Hayward Ca 94544 <br />Customer# 256Q <br />Transpor(er lD#48A1 <br />/-`'-aerator: - Contact: Pat Work: QN) 33d-3750 <br />IWO Country Care Center - Lodi weekly <br />321 West Turner Road Frequency of Service <br />Lodi, CA 05240 Pricing $4566 per Month FLAT -RATE <br />0 Trenofor Facllitr. <br />Bi Destination Facility_ <br />o Alternate Tragafer Feclllty <br />a Doatlnation Feollity, <br />0 Altemate Destination Facitityty Alternate Transfer Facility <br />Barnett Medical Servlces,lnc <br />Barnett Medical services,ine <br />Heahhwlee 8ervioea <br />Photo Waste Recycling Inc <br />Curtia Bey Energy <br />Daniels Sharpsman <br />30620 San Antonio Sl <br />2986 Arch Rd.4200 <br />4800 B, Lincoln Ave <br />2980 Kerner Blvd #C <br />3200 Hawkins Point Rd <br />4144 E. Therese Ave <br />Hayward COO" <br />5tooktorl CA 96216 <br />Fowler CA 93625 <br />San Rafael CA 94901 <br />Baltimons MD 21228 <br />Fresno CA03726 <br />(510)428-9811 <br />(510)429 911 <br />559-834-3333 <br />(416)d68.0807 <br />(410)8$OZ28 <br />659-634-6252 <br />ermit#TS-87 <br />Permit#T'WSTAO0,,,, <br />Perm1twTe.89 <br />Permit #PWR1227e4 <br />Permit#2005-WMILDMI <br />Permit # TS/OST-SS <br />Dela <br />Product Delivered: <br />weight: <br />Waste Collected: UN 3291 Regulated Medlsa( Waste n.o.s. 6.2 PG 11 <br />Sharps Containers <br />Regulated Medical Waste <br />Pharmaceutical <br />Trace Chemotherapy <br />Size Qty: <br />Size Qty: Wt <br />Size Qty: Wt: <br />Size Qty: Wt <br />Up to: <br />3 gal <br />2 gal <br />20 gal <br />8 gal <br />12 gal <br />4gal w `` <br />38 gal <br />9 gal <br />18 gal <br />6 gal <br />40 gal <br />12 gal <br />20831 <br />8 gal <br />44 gal <br />18 gal <br />38 gal <br />12 gal <br />Size Qty Weight <br />"Jal <br />Pathogens <br />Product Delivered: <br />weight: <br />Item #f Description- Qt: <br />I <br />Dental Waste: <br />Amalgam:Siza Qty Fixer:Size Qty Developer: Size Qty <br />L®ad: Size Qt Other: Size Qt <br />Other: Type Slze Qt <br />Notes: ° ! ar 1MV11 a l-5' <br />ea addl tub beyond (6) <br />Generator Certlf)catlow, <br />Generator (Customer) <br />Route Driver <br />Cerd ficate of Dest ru ctlon <br />Incineration <br />IherebVicertify that the contents ofthis oonstnmant are fu1y mtdaccuratelydeecribedabo%ebypropershippingname <br />and are classified, packed, marked, and labeled, and aro In all aspects In pro percondition for transport according to <br />applicable jpvernmanireguladons. <br />I farther d edare that this shiprn enc o f waste is free of hazardous a nd mercury waste in defined by the US cod e o f federal <br />regu lations end/or 3pnroprlatestate rules and regulations. / <br />INaame of authorized person (print) Signa <br />Name authorized person 1prhtl Sign ure 62te <br />Nam a of amhorlted person (print)/� HiQ fur Date <br />Brett Espicha I& -A,9 01/14/2015 <br />Certificate of Destruction <br />Autoclaved Name of authorized person (print) 51griature Date <br />Received Time Feb.25. 2016 11:52AM No,1498 <br />