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Barnett Medical Services, Inc 510429-9911 Ph Date: 08/1912015'-",, <br /> Lm�MLA 0 �i <br /> 3670 Enterprise Ave 510-266-0945 Fax Manifest#'- 77355 <br /> Hayward Ca 94545 Customer# 2232 <br /> EPWA1-000404096 <br /> ierator: Transporter 1DR891 Contact: Sally Solankl WOM:pg)45.2626 <br /> Stockton Hematolociv Onocoloav-StqcK1 <br /> 2620 N CaliforniaSte#3 1 requency of Service weekly <br /> Stockton,CA 95204 Pricing $950-a l7r. <br /> 0 Transfer Facility; N Destinallon Facility: emate Transfer Facility male DoWnation Facility 0 Destination Facility <br /> Daniels SharpsmarOMS Daniels i <br /> 11amett Medical Services Inc Daniels Sharpsmart )&s say Energy Photo Waste Recydlng Inc <br /> 3670 Enterprise Ave 2385 Arch Rd#200 4144 E-Therese Ave 3200 Hawkins Point Rd 2980 Kerner Blvd#C <br /> Hayward CA 94545 Stockton CA 95215 Fresno CA 93726 Ballimore MD 21226 San Rafael CA 94901 <br /> (610)42&9911 (510)429-9911 559.834.8252 (410)354-3228 (415)459.8807 <br /> Permit#TSIOST-1,00 Permit 0 TSIOST-55 Par"(#2005-WMI*M Permit 0 PWR 1122764 <br /> Date11Lr' pato- ' <br /> — <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG 11 <br /> Shams Containers_ Regulated Medical Waste Pharmaceutical Trace Chemgthcrai) <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 /> 49al 38 gal 9 gal 18 gal <br /> 6 gal 40 gal 12 gal 20 gal <br /> Sgal 44 gal 18 gal 38 gal <br /> 12 gal Weight <br /> -al Size Qty Weight Product Nilvemd: <br /> Ought: f!pthogen: Item# Description: Qt: <br /> (Dental Waste., <br /> Amalgam:Sl ze_MY_Fixer,Size_Qty_Developer Sl ze_Qty_ <br /> Lead:Size—QL_ Other:Size_Qt_ <br /> Other:Type Size _Qt_ <br /> Notes; Hours: M-Th 8-30-12:30 11:30-9---ri 8:30-41 <br /> Generator Certification: I hereby certIN that th econten*ts 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 /> applicable government regulations. <br /> I further declare that this shipment of wastee is free of haze us a me rywaste scle n by the US code of federal <br /> regul tions aappropriate state rules a ulalf <br /> Generator(Customer): <br /> Name of uthafped per; *Mnt Signature Dale <br /> 111ilAl <br /> Route Driver <br /> Name of auty6d person(print) Slgryrtum Date <br /> `-dirtificate of Destruction <br /> Incineration Name of authorized person(print) ig ature Date <br /> Certificate of Destruction Brett Espicha elddi 5- <br /> Autodaved Name of authorized person(print) Signature Date <br />