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Feb. 25, 2016 11:490 No. 8337 P. 13/56 <br />Barnett Medical Ser s, Inc 51G -429-z9911 Ph Data: a,3/1J3/4U'E5 <br />30620 San Antonlo 511 nn�42�-c� �4 Fax • Manifest #: 67979 <br />Hayward Ca 94544 San Joaq�'in Gb�7�t�/ Customer# 2560 <br />opo.W77ac orteflD#48A'Environmental Health Department <br />_,wn:DIRECTOR ��gg <br />„'?6U' ' O Lind 8 : 4 <br />t 1868 ,EasVHAWlton Avefte tel#. <br />Care <br />Centegtd bn' Cae�5,klY PROGRAM COORDINATORS <br />r1fornia� <br />6232 <br />r Ond quency eryC® Robert McClellon, REHS <br />Jeff Carruesco, REHS, RDI <br />q ......• �, Website:i;!)Gjgov.or <br />50per r�Iionfh FLAT -RATE Kasey Foley, REHS <br />� � F o R Adrienne Ellsaesser, REHS <br />Phone: (209) 468-3420 Rodney Estrada, REHS <br />ax: y Ng, <br />o Transfer reality: Destination Facility' o Allemale Transfer Facllhy o Declination Fsohlry a Alternate Destination 15-301111y0 Alternate Tranarer Facilf(y <br />Barnett Medical Servires,lnc Harnett Medical Semces,lnc Heeilhmdae Serwces Photo Waste Recycling Inc Curtle Biy Energy DaniBls Sharpamart <br />30020 San Antonio St 2386 Arch Rd #200 4900 E. Lincoln Ave 2960 Kerner Blvd 4C 97.00 Hawkins Pohl Rd 4144 E. Therese Ave <br />Heyward CA 94544 Stockton CA 95216 Fowler CA 93026 San Rsfeel CA 94901 Baltimore MD 21226 Fresno CA 03720 <br />(510) 429-0911 (510) 429-9911 689-8243333 41 8) 469.9807 (410) 354.3228 5584334-6262 <br />Perrrlit4TS-07 Permit 0TSIGST--100 ,,,, JJ�� Permlt#TS-99 ermit A PWR 122764 Perrnft P 2005-WMI-0036 Parmhd757o5T55 <br />Data k - Detegf,.:[.LS`' <br />Waste Collected: UN 3291 Regulated Medical Waste n.o.s. 6-2 PG 11 <br />Sharps Containers Regulated Medical Waste <br />Pharmaceutical <br />Trace Chemotherapy <br />Qg Qty; Size Qty: <br />Wt <br />Size Qty: Wt: <br />Size Qty; Wt <br />up to: <br />3 gal <br />Z gal 20 gal <br />8 gal. <br />12 gal <br />4 gal 38 gal <br />9 gal <br />la gal <br />6 gal 40 gal <br />/'00 <br />12 gal <br />20 gal <br />8 gal 44 gal <br />18 gal <br />38 gal <br />12 gal <br />Size Qty Weight <br />Pathogen: <br />Product Delivered: <br />llve=fght; <br />item 4 Descrlptlon; Qt; <br />Dental Waste: <br />Amalgam:5lze Qty Fixer:Size <br />Qry <br />Developer. Size Qty <br />Lead: Size Qt Other: Size__Qt <br />Other: Type <br />Size <br />Qt <br />rip of S Per <br />Notes: <br />dura: <br />15-5 <br />ea addl tub beycnd (6) <br />Generator Certification: <br />Generator (Customer) <br />Route Driver <br />herebycertHy thettheccrnentSofihl6eon6gnmentarefully and accuratelydescribed above by propershlpping name <br />and are elasslfied,packed, marked, and labeled, and ate In All aspects In proper condition for transportac carding to <br />applicable governmen t regulations. <br />I Nrtherdeclare that this shipment of waste is free of hazardousand mercurywaste as defined by the US cod eof federal <br />resubtlonb and/or approprlate slate rugs ar4regulations. <br />Nano of muthorIA pereon,(prht) 56nature <br />Name of authorized person (prin <br />%.ertificateofpestruccfon <br />Incineration Name of authorized pereon(print) <br />Brett Espicha <br />Cerditcate of Destruction <br />. Autoclaved <br />Received Time Feb,25 <br />Name of auttia riled parson (print) Signature <br />2016 11:52AM No,1498 <br />Date <br />03/04/2015 <br />Date <br />