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Feb, 25, 2016 1 1:49AM <br />Barnett Medical So- s, Inc 510-429-9911 Ph <br />30620 San Antonio 510-429-9914 Fax <br />Hayward Ca 94544 San Joaquin County <br />Poi,, poKerlD#dA9tnvironmental Health Department <br />/—'m alt ? 1868 EastCH1420ton Aveiifffe <br />Care CentegtMn, C#}$n4OPME§232 weekiy. <br />AP narl — <br />F 6,0 <br />No, 8337 P. 10/56 <br />Date: 02PI LLIZUl to <br />Manliest #i: 678716 <br />Customer# 2561 <br />Website: Iifil6l Aigov.org Alper Month FLAT -RATE <br />Phone: (209) 468-3420 <br />DIRECTOR <br />LindaMj�a� <br />PROGRAM COORDINATORS <br />Robert McClellon, REHS <br />Jeff Carruesco, REHS, RDI <br />Kasey Foley, REHS <br />Adrienne Ellsaesser, REHS <br />o Transfer Fadllty: <br />Barnett Medlvat Services,lnc <br />30620 Bop Antonlo 8t <br />Hayward CA94544 <br />(510) 429,9911 <br />Permit It T8-117 <br />Dela <br />Fax: -0138 Willy Ng REHS <br />M Destination Faclllty: o Alternate Transfer V"Ilty o Destination Facility o Alternate Dentlnatlon Fadiltyp Alternate Transfer Facility <br />Barnett Medfcal Services,inc Healthwise Servives Pholo Waste Recycling Inc Curtis Biy Energy Dehiels Sherpsmort <br />2385 Arch Rd 4.2DO 4800 E_ Lincoln Ave 29110 Kerner 01W 0C 3200 Hawkins Point Rd 4144 E. Therese Ave <br />Stockton CA0210 Fowler CA 93M San Rafael CA 04901 Baltlmora MD 21226 Fresno CA 93725 <br />(510) 429-9911 689.836-3333 (415) 459.6507 (410) 364-3225 559-634-e252 <br />Permit* TSIOST-106 perm►t I1 TS 8B Permit # PtNR 1227®4 Permit 0 2OD5-WMI-DO36 Porrnit# TSIOST b6 <br />PatEL,S <br />Waste Collected: UN 3291 Regulated Medical Waste n.o.s. 6.2 PG II <br />Sharps Containers <br />Regulated Medical Waste Pharmaceutical <br />Trace Chemotherapy <br />Size Qty; <br />Size Qty: <br />Wt Slze Qty: <br />Wt: Size Qty: <br />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 />40 gal <br />12 gal <br />20 gal <br />8 gal <br />44 gal <br />18 gal <br />38 gal <br />12gal <br />Size Qty <br />Weight <br />:' :gal <br />Pathogen: <br />Product Delivered: <br />.,eight; <br />Item# Description: <br />Qt: <br />Dental Waste: <br />Amalgam: Size Qty Fixer; 51ze Qtydeveloper: Size Qty <br />Lead: Size Qt Other: Size Qt <br />Other: Type Size Qt <br />Notes: u a s per curs; 8-0 <br />ea addl tub beyond (6) <br />Generator Certif)catton: I herebycertlfy that the contents of this consem„entare fulfy sad 3cwratelydesedbad ebova by proper shipping name <br />and are classffled, pocked, marked, and Isbeled, and are in all aspects in properconditfoh for transport according to <br />applicable governMertreguWohs, <br />I furtherdedare thatthis shipmentofwasw is free orhazardoueend mercurywaste as defined by the US mdeoffederal <br />regulatlon6 afrd/or 6pproprletestate rules regulatfon5. <br />Generator (CuStDfn ir)$---------- <br />NnMa'of authorized person (prht) • 5lgnature Date <br />Route Driver <br />Certificate of Destruction <br />Incineration <br />Name of6thorized person (prod Signature <br />N ama of authorized person (print) <br />Brett'Esplcha <br />Certificate of Destructlon <br />Autodaved Name ofaulhodzod por-w (print) Signature <br />R e c e 1 v e d The Feb, 25. 2016 11:52AM No, 1498 <br />Date <br />02/12/2015 <br />Date <br />