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35� <br /> AltBarnett Medical Services, Inc 510-429-9911 Ph Date: 02,93 2916 <br /> W <br /> 3670 Enterprise Ave 510-266-0945 Fax Manifest#: 87879 <br /> Hayward Ca 94545 Customer# 223 <br /> 1EPA#CAL000403598 <br /> Transporter ID#4891 <br /> ierator: Contact: <br /> Stockton Hemptolociv Onocolow - Stock, <br /> "K6 N' C-iV-friia-t --m#:; Frequency of Service <br /> 'K-; ! % -1 :1-1 - '-' cam-` <br /> CA 9521-54 Pricing -A <br /> o Transfer Facility: C1 Destination Facility- -te Transfer Facility pl.th;;ale Destination Facility ri Destination Facility <br /> .13 <br /> Danlels SharpsmartfBMS Barnett Medical Services,lnc Daniels Cu is ay Energy Photo Waste Recycling Inc <br /> 3670 Enterprise Ave - 2385 Arch Rd#200 4144 E.Theresa Avo 3200 Hawkins Point Rd 2980 Kamer Blvd AC <br /> Hayward CA 94546 Stockton CA 95215 Fresno CA 93725 Baltimore IVID 21226 San Rafael CA 94901 <br /> (510)429-9911 -9911 55"34-6252 (41110)354-3228 (415)469-8807 <br /> Parmlt#TS-125 (510)429 0�0 Permit#TS/OST-65 Permit#2005-YVMI-0036 Permit#PWR 122764 <br /> Date it#Ts"Cs"'1; 3 <br /> Dale <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PIS 11 <br /> Sharps Containers Regulated Medical Waste Pharmaceutical Trace Chemotherapy <br /> Size Qty: Size Qty,. Wt Size Qty: Wt: Size Qty: Wt <br /> Up to, 3gal <br /> 2 gal 20 gal 8gal 12 gal <br /> 4 gal 38 gal j 0 9 gal 18 gal <br /> 6gal 40gai 12 gal 20 gal <br /> 8 gal 44 gal 18 gal 38 gal <br /> 12 gal Weight <br /> A Size Qty Weight Product Delivered: <br /> Weight: Path Item# Description: Qt: <br /> Dental YVaste: <br /> Amalgam;Size_Qty_Fixer:Size_Qty_Developer:Size Qty <br /> Lead:Size Qt Other:Size Qt <br /> Other:Type Size—Qt <br /> Notes: !-Iours rvi-111 t::7712-3-J77-777 --rl = m"i-'-Jl <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 all aspects In proper condition for transport according to <br /> applicable government regulations. <br /> I further declare that this shipment of waste is free of hpfsr ous a dmercur teasd fi d bythe US code of federal <br /> re cations and/of appropriate 5ta te rules and regulaons. <br /> Generator(Customer) pflrl <br /> Name of authorized person(print) I Signature Date <br /> Route Driver 41�4� <br /> �R A/3 <br /> Name of aut'T601`12ed person(print) Signature Do Date <br /> Certificate of Destruction <br /> Incineration Name of authorized person(print) Signature Date <br /> Certificate of Destruction aN@&h Iq M- �-Q <br /> Autodaved Name of authorized person(print) Signature Date <br />