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Feb, 25, 2016 11:50AM No, 8337 P. 16/56 <br />Barnett Medfoal Serve, Inc 510-429-9911 Ph Date: 332412W to <br />30620 San Antonio St 4A-n�&-RQ4 Fax Manifest #: 70995 <br />ayward Ca 94544 San JoCustomer# 2500 <br />DRQ a orteriov891Environmental Health Department DIRECTOR <br />Linda-TuCk(a� <br />y-A 1868 Eas>>v )ton AvelPape o . 7 <br />Care CenteeSth n, California 95205-6232 yveaki PROGRAM COORDINATORS . <br />Frequency of Service Robert McClellon, REHS <br />' fit r r cad Jeff Carruesco, RENS, RDI <br />FF WebsiteMYNA gsjgov.or cPLr Month FLAT-RATE Kasey Foley, REHS <br />Lr r p'F2 Adrienne Ellsaesser, REHS <br />Phone: (209) 468-3420 Rodney Estrada, REHS <br />o Trensfsr Facility Destination Facility_ o Alternate Tranafer Facility o uagttnailon Facility a AAarnste Deetinatian Facilityo Alternate Transfer Facility . <br />Hemet( Medioal 8ervices,lno 9ematt Medioal Servicee,lrne Homlthwlee SAIV1060 Photo WaftReoycling Ino Comic 100 0101`0Y penlela Sherpsmart <br />30620 0&0 Antonio 61 2386Arch Fid 1/200 4800 E- Lincoln Ave 2960 Kamer Blvd 4C 3200 Hawkins Point Rd 4144 a Tlieraae Ava <br />Heyward CA 94544 Stockton CA 95215 Rmter CA93625 San Rabel CA 94901 Baltimore MD 21226 Prwgno CA 93725 <br />(510) 4.29.9911 (510)429-9911 559-834-3333 (415) 459 8807 (410) 354-3928 559 834-0252 <br />Permtt#TS-87 Permit#TWOST-106 Petmlt#15-80 Permit. #PWR122764 Permw#2005-WMI-0036 Pen+vtOTS/03T,55 <br />Dole _Dabe-VA <br />Waste Collected: UN 3291 Regulated Medical Waste n.o.s. 6.2 PS II <br />Sharps Containers Regulated Medical Waste Pharmaceutical Trace Chemotherapy <br />Size Qty: 51Z-Q Qty: Wt Size Qty. Wt: �t&z Qty: Wt <br />Up to: 3 gal <br />2 gal 20 gal 8 gal 12 gal <br />4 gal' 36 gal 9 gal 18 gal <br />6 gal 40 gal p 12 gal 20981- <br />8 <br />0gal- <br />8 gal 44 gal 18 gal 38 gal <br />12 gal Size City Weight <br />�- -al PathogeiL MOO Delivered; <br />1Neight: Item # Descrlptlon: Qt: <br />Dental Waste; <br />Amalgam: Size Qty__ Fixer, Size Qty Developer: Size Qty <br />Lea d: Size Qt Other: Size Qt <br />Other: Type Size Qt <br />Notes, upto(0) s pe$76 Hours: ' <br />ea adtil tub beyoncl (6) <br />Generator Certif-teation; IherEbycertify that thecontettt5ofthis con signmentare fuIVandaccurately descnhedabovebvproper5hippingname <br />and arrk�Glawf d, packed, marled, and labeled, and are in allespect5ln proper condition for tran5portaccording to <br />applicable 1�vernrn int ragulagotvs. <br />I further'declarethetthis 5hipmentofw is a of hazardousand mercury a e as defined by the U5 codeoffederal <br />reEptations and/or appropriate state ru sand egUletions <br />Genemtor(Customer) 1�fylraim -46-- <br />Name or authorized person (print) re Date <br />Route Driver e- a /—/ <br />Nae of authorized person (print) Signature ate <br />nc <br />Cerd 8cate Of De3tM cll ott <br />Incireratlon. Nape of authorized person (ptintl�n tun Date <br />Brett Espicha 03/25/2025 <br />Certificate of Destruction _ <br />Autodaved Nameofauthorizedperson (print) -Signature Date <br />Received' Tire Feb, 25, 2016 11:52AM No, 1498 <br />