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T­2 0 1 <br /> Barnett Medical Services, Inc 510-429-9911 Ph Date: 0 1 88962 G <br /> 3670 Enterprise Ave 510-266-0945 Fax Manifest 4: <br /> as,TO:0 <br /> I NVA Aftj Hayward Ca 94545 Customer# 2232 <br /> '4111W EPA#CAL000403598 <br /> Transporter IDI/4891 <br /> ierator: Contact: <br /> Stockton Hematolociv Onocoloav - StPraq"u'ency wee'r-1v <br /> of Service <br /> 22"26 17!C-Aforr!ip St.S'L.=x3 F�LkT RAT,E <br /> -A 3E-2154 Pricing <br /> o Transfer Facility. X Destination Facility: to Transfer FacilityXAlternate Destination Facility c; Destination Facility <br /> Daniels Sharpsrna"MS Barnett Medical Services,lnc X=1.1 Shafpsmarl 4;.fus Bay Energy Photo Waste Recycling Inc <br /> 3670 Enterprise Ave 2386 Arch Rd#200 4144 E.Theresa Ave 3200 Hawkins Point Rd 2980 Kamer Blvd#C <br /> Hayward CA 94545 Stockton CA 95215 Fresno CA 93725 Baltimore MD 21226 San Refeel CA 94901 <br /> (510)429-9911 (510)429-9911 559834-6252 (410)354-3228 (415)459-8807 <br /> Permit#TS-125 Pe TS/OST-106 I Permit#TSIOST-55 Permit#2005-WMI.0036 Permit#PWR 122764 <br /> Date Dalow? <br /> Waste Collected: UN 3291 Regulated Medical Waste in.o.s.6.2 PIG 11 <br /> Sharps Containers Regulated Medical Waste Pharmaceutical Trace CheMpLhera <br /> Size Qty: Size Qty: Wt Size Qty: Wit: Size Qty: Wt <br /> Up to: 3 gal <br /> 2gal 20 gal 8 gal 12 gal L <br /> 4 gal 38 gal C) 9 gal 18 gal <br /> 6 gal 40 gal 12 gal 20gal <br /> 8 gal 44 gal 18 gal 38 gal <br /> 12 gal Weight <br /> I -al Size Qty Weight Product Delivered: <br /> Weight: Pathogen: Item# Description: Qt: <br /> Dental Waste: <br /> Amalgam:Size_Qty Fixer:Size Qty_Developer:Size_Qty_ <br /> Lead:Size Qt_ Other,Size Qt_ <br /> Other:Type Size Qt <br /> Notes: Hours M-Th 2:3G-42-30 1 '1 F-ri 8:30-4 <br /> Generator Certification. I hereby certify that the contents of this consignment are fully and accurate[Vdesc(lbed above by proper shipping name <br /> and are classified,packed,marked,and labeled,and an-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 hazard san mer rywasteasdeft d the US code of federal <br /> regulations and/or appropriate state rules and re ulattions <br /> Generator(Customer) A'W4 <br /> Name of authorized person(print) Signature Date <br /> Route Driver f&k V �"() -—-<-K--) g I <br /> Name ofauthori.,/d person(print) Sgnature Date <br /> --certificate of Destruction <br /> Incineration Name of authorized person(print) Signature Date <br /> Certificate of Destruction 016 <br /> Autoclaved Name of authorized person(print) Signature Date <br />