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Feb, 25. 2016 11:49AM <br />8337o,ZP 8/56 <br />Sharps Contalners <br />Barnett Medical Se S, Inc = 510-429-9911 Ph <br />palloo. <br />1578-14 <br />Lb <br />f <br />30620 San Antonio 510-429-9914 Fax* <br />Manifest#. <br />Customer# 2600 <br />Size Qty; Wt: <br />Hayward Ca 94644 San Joaquin ounty <br />Up to: <br />OPQUt c porterlb#489tnvironmental Health Department DIREr <br />' 7� <br />�\ ). — <br />n >�t <br />ri <br />OG <br />'�8 EastgI4426 ton Avenue <br />Care Centegto <br />B <br />PROGRAM COORDINATORS <br />U): <br />8 gal <br />n, C L RPM&232 weekly <br />$�Lf,� HT'�T1yl� <br />CC IITTIrI <br />4 gal <br />38 gal <br />9 gal <br />1}t 4�Q <br />Robert McClellon, REHS <br />q ......'. <br />$456 per MorRf� 1 IAT �14T� Jeff Carruesco, REHS, RDI <br />�;�P Website; ajgov.org/ehd Kasen Foley, REHS <br />20 gal <br />Phone: (209) 468-3420 <br />Adrienne Ellsaesser, REHS <br />Rnrinay Fctrnd;; RFHS <br />18 gal <br />Fax: (209) 464-0138 <br />Willy Ng, REHS <br />A Transfer Facility: <br />CR Destination Facll%r: a AI(ernst®Tranarer Faolllty p Destination Facility o <br />Alternate bestinatlon F90111tys Alternate Transfer Facility <br />Barnett Medical Servlces,trw Barnett Medical Servicee,lnc HeaMwlse Services Photo Waste Recycling Inc <br />Curtis Bay Energy Denlole Snarpamart <br />30620 Sari Antonlo St <br />2886Aroh Rd *200 4800 E. Lincoln Ave 2990 Ktrltter Blvd #0 <br />3200 Hawklne Polnt Rd 41448. Therese Ave , <br />Hayward CA94544 <br />Stackran CA 96216 Fowler CA 9a62.6 San Rafael CA 94901 <br />IleAlmore MD 21225 Fresno CA 93725 <br />(510) 429-9911 <br />ermlt it T"7 <br />(510) 429-9911 869-8344333 (416) 459.6807 <br />Permit 4 TS/OST 106 Permt it T6-89 Permit rF PWR 122764 <br />(410) 35d-3228 559-834-6252 <br />Permit # 20W-WM1-0036 permit 0 T19/08T--55 <br />Amalgam:size <br />Qty FlxertSizo Qty <br />Dwe <br />_pote�Wls <br />lead: Size ' Qt <br />Waste Collected: UN 8291 Regulated Medical Waste n,o.s. 6,2 PG If <br />Sharps Contalners <br />Regulated Medical Waste <br />Pharmacqujigi <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 />4 gal <br />38 gal <br />9 gal <br />18 gal <br />6gal <br />40 gal _ <br />12ga1 <br />20 gal <br />8 gal- <br />44 gal <br />18 gal <br />38 gal <br />12.gal <br />Size qty Weight <br />pathogen: <br />Product Delivered: <br />Welght: <br />Item # Description: Qt: <br />Dental Waste: <br />Amalgam:size <br />Qty FlxertSizo Qty <br />Developer: Size Qty <br />_ <br />lead: Size ' Qt <br />Other: Size Qt <br />Other. Type <br />__ Size <br />_ Qt____ _ <br />Notes: -,—k-'---,.pi. - <br />ea addl tub beyond (6) <br />Generator Certification: I hereby ceruk that thacontents of this can sgnmentare fully and accuratelydeecdbad above by proper shipping name <br />and are classlfied,pitked, "rr,8rked, and labeled, and are in all aspects in pro per condition for transport ecoording to <br />a opllcable 0o vernm in t regulations. <br />I furtherdedare thatthls shipments ste free of hazardous m curywafite as defined by the us codeof federal <br />C� regu lationc and/or appropriate sta 6 nr les d regulations. <br />Generator (Cdstalmir)_ hS <br />Name sfauthorized parson (print).ore' Dat <br />��4Route Driver �I)��► _ <br />/-\ <br />Cerdflcate of Destruction <br />Incineration <br />Namn ofiuthorizad person (print) Signature <br />Name of authorized parson (print) <br />Brett Esplcha <br />to <br />Date <br />01/29/2015 <br />Certificate of Destruction <br />Autoclaved Name of euthodied person (print) signature Date <br />Recelved Time Feb,25, 2016 11:52AM No -1498 <br />