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Barnett Medical Services, Inc 510-429-9911 Ph Date: 08105/2015 <br /> ®� 3670 Enterprise Ave 510-266-0945 Fax Manifest#: 77353 <br /> Hayward Ca 94545 Customer# 2232 <br /> EPA#CAL000404096 <br /> Transporter 10#4891 f lerator: Contact: Sally Solanki WorK:rZ,W)4W2M <br /> Stockton Hematolotly QnocologV- SFrequency of Service w�i kly <br /> .20215N Galtfofnla St,Ste#3 <br /> Stookton,CA 25204 Pricing $950 a Mo. <br /> f]Transfer Frailty Destinadw Facility: $41emate Transfer Facirrly /�Aftemate Deatination Fadity, O Destination Facility <br /> Daniels SharpsmertIBMS Bamett Medical Servioes.tnc Daniels Sharpsmart � LbrUs Bay Energy Photo Wasle Recycling Inc <br /> 3670 Enterprise Ave 2385 Arch Rd#200 4144 E.Therese Ave 3200 Hawkins Point Rd 2900 Kerner Blvd#C <br /> Hayward CA 94545 Stockton CA95215 Fresno CA 93725 Baltimore Mo 21226 San Rafael CA94901 <br /> {510)429 9911 (510)429-9911 659.8348252 (410)354-3216 (415)4598807 <br /> Pomrit#TS/0ST106 Permit#TWOST-55 Pefmk#2005-WMWM PermB#PWR122764 <br /> Date .�)lf- 'ate �� <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG If <br /> jhaMs Containers Iteiglated Medical Waste Pharmaceutical Trace Cheyiot eraox <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 /> 4gal 38 gal /� 9gal 18 gal <br /> 6 gal 40 gal 12 gal 20 gal <br /> 8 gal 44 gal 18 gal 38 gal L <br /> 12 gal Weight <br /> 31 Size Qty Weight Product Delivered: <br /> 1Wght: Pathogen: Item# Description: Qt: <br /> Ne t e: <br /> Amalgam:Size Qty Flxer:Size Qty Developer:Size Qty <br /> Le ad:Size Qt Other:Size Qt <br /> Other:Type Size Qt <br /> Notes: Hours: M-Th 8:30-12:30 11:30-6, ri 8:304 <br /> Generator Certiftcatlon: I herebycertify that thecontents of this consignmentare 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 /> applicable government regulations. <br /> I further declare that this shipment of wast Is free of hazardous and mercvrywaste as defined by the US codeof federal <br /> regulations and/or appropriate state rules a r dons. <br /> Generator(Cxtstomer) M @ <br /> Name of authorized person print) Signature Date <br /> Route Driver <br /> Name of auk rized person(print) Slgnat Date <br /> Certificate of Destruction '— <br /> Incineration Name ofauthoriz de arson(print) Signat� ate <br /> Certificate.of Destruction Brett Espicha <br /> Autodaved Name of authorized person(print) Signature Date <br />