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i <br /> Barnett Medical Services, Inc 510-429-9911 Ph Date: 07129:2015 <br /> ®� 3670 Enterprise Ave 510-266-0945 Fax Manifest#: 77352 <br /> Hayward Ca 94545 Customer# 2232 <br /> EPWAL000404096 <br /> Transporter ID#4891 <br /> ( )erator: Contact: Salty 5olanki vkforli:P9)4615,2626 <br /> Stockton Hematotow Onocoio(ty-Stpcl1 weekl <br /> 2Q26 N Califomia St.Ste#3 requency of Service y <br /> Stockton,CA 95204 Pricing $950 a�• <br /> CI TransferFadttiy: 0 Destination FarAity to 7tansfer F..ft ato Destination FadWy ®Destination Facility <br /> taehils SharpanraMMS Barnett Medical Sarv)coa,lne Da Ws arterpsrrrar /Utem <br /> t Bay Enorgy Photo Waste Regyc"Me <br /> H <br /> CA ise Ave 2385 Amh Rd#200 4144 E.Theme Ave 3200 Hawkins Point Rd 2880 Kerner Blvd#C <br /> Staddon CA 95215 Fresno CA 93725 Baltimore MD 21228 San Rafael GA 94901 <br /> (510)429-9911 (510)429.99t1 669.83"252 (410)364-33228 (415)439-M07 <br /> Permit#7S/OST 108 Permit#T&OST-55 Pemdt#2005-WMI-0030 Pambt#PM 122764 <br /> Date <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG II <br /> Sharps Containers Regulaftid Medical Waste Pharmaceutical Trace Chemotheralpv <br /> Size Qty: Size Qty: Wt Size Qty: Wt: Size Qty: Wt <br /> Up to: 3 gal <br /> 2 gal 20 gal 8 gal 12 gal <br /> 4 gal 38 gal 0 9 gal 18 gal <br /> 6 gal 40 gal 12 gal 20 gal <br /> 8 gal 44 gal 18 gal 38 gal <br /> 12 gal Weight <br /> al Size Qty Weight Product Delivered: <br /> Dight: Item# Description: Qt: <br /> Dental Waste, <br /> Arnalgarn:Slze qtyFixer:Size Qty Developer:Size Qty <br /> lead:Slze Qt Other.Size Qt <br /> Other:Type Size Qt <br /> Notes: Hours: f'v-Th B:30-12:3 1 : ri 8:30-4 <br /> Generator Certification: I hereby certify that the contents of this consignment are fully and accurately described above by proper shipping name <br /> and are classified,packed,marked,and labeled,and are in allaspects In proper condition for transport according to <br /> appllable government regulations. <br /> I further declare that this shipment of waste is free of zard so me ry wast defined by tate us eodeof federal <br /> re$ula ions an or ppropriate state ndes and u ons. <br /> Generator(Customer) r f: 1 <br /> ,Name ofauthorized person(print) g ure Date <br /> Route Driver <br /> Name ofautho zed person(print) SignaWrer Date <br /> `6r6flcateofDestruction ff ' <br /> Incineration Name of authorized person(print) Si na ure Date � <br /> Brett Espicha -7(3A <br /> Certificate of Destruction j <br /> Autodaved Name of authorizedperson(print) Signature Date <br />