Laserfiche WebLink
Feb, 25. 2016 11:50AM No, 8337P, 15/56 <br />Barnett Medical Se , Inc 510-429-9911 Ph Date: 031 t ILu t <br />30620 San Antonio 5l� 511 n�1�-42c�-coq 4 FaX Manifest #: 70005 <br />' Hayward Ca 94544 San Joaquin C�ol�t'ity Customerk 2560 <br />NOV! a orterlD0489tEnvironmental Health Department DIRECTOR <br />Linda. a Swam <br />t, ? 1868 Easil�t> iton Ave de <br />Care Certain bin, C lifornia 0�-6232 weekly PROGRAM COORDINATORS <br />.P oad �requency OT bAN Ce Robert McClellon, REHS <br />Jeff Carruesco, REHS, RDI <br />4 wer Month FLAT -RATS Kasey Foley, REHS <br />q4.i F o•0' Website: 9FW) Nffijgov.org e d Adrienne Ellsaesser, REHS <br />Phone: (209) 468-3420 Rodne Estrada, REHS <br />Fax. —(211.1119)464-0138 VV1y Ng, KtzMb <br />Ci Thiinefer Feolllty: 04 Destination Fgollity: o Ailemate.Transfer Fealllty o Destination Facility o Alternate Detlinetion Fecililyo Alternate Transfer Facility <br />Bame4lMedlcal SeMoea,lno 6arneh Medlcel 9e.Mces,lm HOMI& 36 8etvlces Pnow Waem Reoyding Ina Curtis Bay FneTay Danle)s Sharpsmart <br />30620 San Antonio St 2995 Arch Rd 4200 480D E. Lincoln Ave 2980, Kerner Blvd *C 3200 Hawkins Point Rd 4144 E Therese Ave <br />Hayward CA 94544 Stockton CA 95215 Fowler CA 9362b San Rafael CA 94901 BaldrnDre MD 21226 Fresno CA 99726 <br />r10)429-0911 (b10)429-9911 659-934-3333 (415)459-61107 (410)964-3228 55934-6252 <br />ennit o Tr's-67 Com i 0 T$109T-100 Parmlt # TB -AG Permlt 0 FVVR 122764 Permit 4 2D05-WMI�D38 Permit # TS/OST-55 <br />Data JtY' Date�M/jY <br />Waste Collected; UN 329. Regulated Medical Waste n.o,s. 6.Z PG it <br />sharps Containers Regulated Medical Waste „pharmaceutical Trace Chemotherapy <br />Size Qty: Size Qty: Wt Size Qty: Wt; 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 />19 gal <br />6 gal <br />40 ga I <br />12 gal <br />20 gal <br />8 gal <br />44 gal <br />18 gal <br />38 gal <br />'12ga1 <br />Size Qty <br />Weight <br />mal <br />Pathogen: <br />ProduF1 DeUve <br />vvt_ight: <br />Item # Description: <br />Dental Waste: <br />Arnalgam:size <br />Qty rixerSize <br />Qty <br />DeVeloper:Size <br />Qty <br />Lead151ze <br />Qt Other: Siz® <br />Qt <br />Other: Type <br />Size <br />Qt <br />Notes: <br />uprat. 1 P P7107-5 <br />ea addl tub beyond (g) <br />Qt: <br />Generator certification; I hereby certify that th a contents of this can sgnmant are fuIV and accurately described above by proper shipping name <br />and are ctaaslfled,pscked, marked, and labeled, and are in all aspects In pro per condition for transport according to <br />e peel able ®overnin on t regu(sdons _ <br />I further declare thatthis shipment of waste is free of haza rdou s a nd merarrywaste as deflned bylhe US cod eoffadaral <br />reguhtiarts and/or appreprlate state rules and reguiatlons. <br />.Generator (Customer) ___ <br />Narne of authorized person (print( <br />Route Driver�z <br />Name of authorized person (prin d <br />,;ertlfi(cate of Destruction t� \ _ <br />Incineration Name ofau orizedperson(print) <br />Brett Esplcha <br />sIg <br />Certificate of Destruction _ <br />Autoclaved Nameofauthorized person (print) Signature <br />Received Time Feb,25, 2016 11:52AM No,1498 <br />Da <br />Date <br />03113/2015 <br />Date <br />