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Feb, 25. 2016 11:49AM No, 8337 P. 11/56 <br />Barnett Medical Se , Inc 51(%429;9911 Ph Date: ��''► rl�u 10 <br />�,,� qq � Manifest #: 67877 <br />30620 San Antonlo SIP' <br />JoPC��rY�oilRSt Fax Customer# 2560 <br />ayward Ca 94544 <br />Nqv! an urterlDllt4691Environmental Health Department DIRECTOR <br />Lind <br />1868 EasCblton AveFffieg <br />Care Centeis#&dKibn lifornia 05-6232 - weekl PROGRAM COORDINATORS <br />Dad I'9quenoy d 5®Nlce 1 Robert McClellon, REHS <br />Jeff Carruesco, REHS, RDI <br />Website:R jgov.or&WcPer Morith FLAT RATE Kasey Foley, REHS <br />Adrienne Ellsaesser, REHS <br />Phone: (209) 468-3420 Rodney Estrada, REHS <br />Pax. (209) 4647-01138 Willy Ng, REHS <br />o Transfer Fadllty- 0 Destinauon Facllld: o Altemalo Trenerer Fedllty P Destinalion FacllRy o Alternate Doatlnalli R dlityo Alternate Transfer Faclllpr <br />Barnett Medical Sarvices,lne Barnett Medical ServiceiOnc Heallhwlse Services Photo Waste Recycling Inc Curtis Bay i=nergy Daniels 8herpumart <br />30030 506n Ammnto 81 2385 Arch Rd $200 4600 E- Lincoln Ave 298D Kenner 81vd #11 3200 Hawkins Polni Rd 4144 E, Tberaaa Avg <br />Heyward CA 94644 stockion CA 96215 Fowler CA 93026 San Rafael CA 84601 Baltimore MD 21226 Fresno CA93725 <br />(610) 428-9911 (510) 429-9911 668-834-3383 (41S)459-880-1 (410) 354.3228 558-834&252 <br />Permit 9 T"7 Permit OTSIOST 106 Permit Wrst s9 PBnnt VPWK 122764 Perm1t u 2005•WMI-0036 PefmllO T8109T-55 <br />,��Dato �Da1� <br />Waste Collected: UN 3291 Regulated Medical Waste n.o.s. 6.2, PG 11 <br />Sharps Containers_ <br />Regulated Medical Waste <br />Pharmaceutical <br />Trace Chemotherapy_ <br />Size MY; <br />Size Qty: Wt <br />Size Qty: VA: <br />Size 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 />is 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 />12 gal <br />Size Qty weight <br />/`•at <br />Pathogen: <br />Product Delivered: <br />1lvelght: <br />Item # Description: Qt: <br />Dental Waste: <br />Anna lgam:Sire Qty Fixer;Size Qty Dave IoperSize Qty <br />Lead :Size Qt Other_Size Qt --- <br />Other: Type size Qt <br />Notes: - <br />ea azial tub- beSy iid (9) <br />Generator Certification: <br />Generator (Customer) <br />Route Driver <br />4erdfieete of Pestructian <br />Incineration <br />I hereby certify drat to ar:ontents ofthis consignment are rully and accuratelydamrlbid above by proper shipping name <br />and ere tia39lfled,pecked, marlard, and labeled, and are In all aspect In proper condition for crampon according to <br />applicable bvvernmant regulations. <br />Ifurtherdedare that this shipmentofwaAeisfree ofhatardousandins a6ter,definedbytrieUScodeoffederal <br />regulations and/or appropriate state rulesandregulatio2s. �, A <br />Nems ofeuthorized person (print) <br />Name otauthorfzed person (prt, U Signature ( DAte <br />Name of authorized person (print' <br />Brett Esplcha <br />Date <br />02/20/2015 <br />Certificate of Destruction _ <br />Autoclaved Name of authorized person (print) Signature Date <br />Received Tire Feb,25. 2016 11:52AM No -1498 <br />