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Barnett Medical Services, Inc 5104299911 Ph Date: 08/12/2015 <br /> 3670 Enterprise Ave 510-266-0945 Fax Manifest : 77354 <br /> Hayward Ca 94545 Customer# 22`32 <br /> EPA#CAL000404095 <br /> Transporter ID94891 <br /> ferator: Contact: Sally Solanki work:(.A)456-20^«5 <br /> Stockton Hematotogv Onoco(ogv -Stock! weekly <br /> 2620 iV California 5t,5t?#„ <br /> Frequency of Service <br /> Stockton-CA 95204 Pricing $950a ny-W, <br /> O Transfer Faddy. W Destination Facility: temate Transfer FacilityAltsmate Destinstfon Facility Q Destination Facility <br /> Daniels Sharpamert/BMS Barnett A4edkxi 3eMces,lnc D mels ShaMamart Curtis Bay Energy Photo Waste Rocyc"krc <br /> 3870 Enterprise Ave 2385 Ards Rd#200 4144 E.Therese Ave 3200 Hawkins Point Rd 2980 Kamer Blvd#C <br /> Hayward CA 94545 Stockton GA 95215 Fresno CA 93725 Baltimore MD 21226 San Panel CA 94901 <br /> (510)429.9911 (510)429.9911 559.834.6252 (410)354-3228 (415)459-8807 <br /> Permit#TS/OST106 Permit#TS/08T•55 Permit#2005-WM14)M Permit#PWR 122704 <br /> Date y11 Date <br /> Waste Collected: UN 3291 Regulated Medical Waste n,o.s.6.2 PG II <br /> S a s!prttainers Regulated Medical Waste Pharmag tical Tmge Chemotherapy <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 �_ �I 9gal 18gal <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 Dellymd: <br /> VVal4ght; tho e • Item# Description: Qt: <br /> DentalWaste: <br /> Amalgam:Size Qty_Fixer:Slze Qty Developer:Size Qty <br /> Lead:Size Q4 Other.Size Qt <br /> Other:Type Size Qt <br /> Notes: oUrS: M-1h8:30-12:90 ri 8:30-4 <br /> GeneMor Certlficatbn: i hereby certify that the contents 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 waste Is free of h ar s a mercurywaste a defiry d by the US code of federal <br /> regulations and/or appropriate state nies a ui ons. >� <br /> Generator(Custvmed / O <br /> Name of authorized rson(print Signature �j Date <br /> Route Driver A/4 A 67 Sal ifs--- <br /> Name of aur prized person(print) Signa Date <br /> "rC rtiflcate of Destruction <br /> Incineration Name of authorized person(print)- Date <br /> Certificate of Destruction__ Brett Espicha <br /> Autoclaved Name of authorized person(print) Signature Date <br />