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Barneft Medical Services, Inc 510-429=9911 Ph Date: 0$12612015 <br /> 3670 Enterprise AveManifest#: 77356 <br /> Hayward Ca 94545 510-266-0945 Fax 2232 <br /> EPA#CAL000404096 CUStOilit?t <br /> Transporter f0#4891 <br /> Wator: Contact: Sally Sotanki wow.: 466-2626 <br /> Stockier( Heitia"01100V OFIOCe IOQV--4-91ocki <br /> 2020 N Calflomfa St,Ste� Frequency of Service `+pekt} <br /> Stockton,CA 95204 Pricing ro$950 a r . <br /> O Transfer Facility: 0 Destination Facility: Alternate Transfer Fadtlry larnate Destinatkm Feclll <br /> Daniela ShaipsmartlBMS Barnett Medical Services ino Daniels Sharpsmart M Ba Energy ty Q holo Waste <br /> F Recycling <br /> 3670 Enterprise Ave 2385 Arch Rd#200 4144 E.Therese Ave y Photo Waste Recycling Inc <br /> Hayward CA 94545 Stockton CA 95215 Fresno CA 93725 3200 Hawkins Point Rd 2980 Kerner Blvd#C <br /> (510)429.9911 (510)429 9911 559-8U-0252 Baltimore MD 21226 San Rafael CA 94901 <br /> Permit#T&OST 108 Perma#TSlOST-55 (410}354228 (415)459-9607 <br /> Date Date —/ <br /> ermft#2p05WMJ-0036 Permit#PWR 122764 <br /> f�A S <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG n <br /> Sharps Con lners .12&W ted ed sal Waste Pharmaceutical Tr <br /> Sace Chemotheravv <br /> Size Qty: Size Qty: Wt Size Qty: Wt: Size <br /> Up to: Qty: Wt <br /> 3 gal <br /> 2 gal 20 gal 8 gal 12 gal <br /> 4gal 38 gal _ 99al 18gal —� <br /> 6 gal 4()gal 12 gal 20 gal <br /> 8gal 44ga1 18ga1 3t3gal <br /> 12 gal Weight <br /> al Size Qty Weight Produ Delivered' <br /> Weight: Pat a Item# Description: qt: <br /> Dental 1WNte• <br /> Amatgam:Slze Qt1+ Fixer:Size QtyDeveloper: Qty <br /> Lead:Size Qt Other:Size Qt <br /> Other:Type Size Qt <br /> Notes: � - n <br /> Generator Certification: I hereby eartlfy that the contents of this consignment are fully and accurately described above <br /> pi <br /> and are classified,packed,marked,and labeled,and are in aliaspects In proper condition for trannsporrt ccorroper dingto me <br /> applicable government reguiadons, <br /> I further declare that this shipment of=- <br /> aste Is flee of ous nd mercury waste as defined by the US rodeo f federal <br /> regulattons and/or appropriate state rides and regul ons <br /> Generator(Cust(omer) <br /> B-a�,s- <br /> Nameofauthorizedpers (print) 5ignature <br /> Date <br /> Route Driver u n P C`L(0-4 <br /> Name of autho Ized person(print) Sigpetwe <br /> Date <br /> Certificate of DestruCtion . <br /> Incineration Name ofauthoriz ed person(print) $ig atura Date <br /> Certificate of Destruction Brett Espicha <br /> Autodaved flame of authorized person(print) Signature Date <br /> J <br />