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8 8- <br /> Barnett Medical Services, Inc 5*410-429-9911 Ph Date: O' 24,2016 <br /> 3670 Enterprise Ave 510-266-0945 Fax Manifest#: 89459 <br /> IV k nm Hayward Ca 94545 Customer# 2232 <br /> "tilillEW EPA#CAL000403598 <br /> Transporter ID#4891 <br /> aiilv Z. <br /> ierator: Contact: <br /> Stockton l4ematolotiv Onocolow - IS <br /> YrCelkiency of Service <br /> 2-312f-',N r:3)iF-irni2 St,Stc-#'7j- <br /> FA�E <br /> Pricing <br /> o Transfer Facillity, 0 Destination Facility: to Transfer Facility t4rate Destination Facility o Destination Facility <br /> Daniels Sharpsmart/BMS Barnett Medical Services,inr V—D".riz.3harpsmart is Bay Energy Photo Waste FtLx-yctlng Inc <br /> 3670 Enterprise Ave 2385 Arch Rd#200 4144 E.Therese Ave 3200 Hawkins Point Rd 2980 Kerner Blvd 9C <br /> Hayward CA 94545 Stockton CA 95215 Fresno CA 93725 Baltimore MD 21226 San Rafael CA 94901 <br /> (510)429-9911 (510)429-9911 559-834.6262 (410)354-3228 (416)459-8807 <br /> Permit N TS-126 Permit#TSIOST-1 0 Permit#TS/OST-55 Perrinit#2005-WMI-0030 Permit#WR 122764 <br /> Date Datawq/0 <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG 11 <br /> Sharps Containers Regulated Medical Waste Pharmaceutical Trace Chemotheraov <br /> Size Qty: Size Qty: Wt Size Qty: Wt: Size Qty: Wt <br /> Up to: 3 gal <br /> 2gal 20 gal Sgal 12 gal <br /> 4 gal 38 gal 73 9 gal 18 gal <br /> 6 gal 40 gal 12 gal 20 gal <br /> 8 gal 44 gal 18 gal 38 gal _L 7 <br /> 12 gal Weight <br /> ,al Size Qty Weight Product Delivered: <br /> Weight: Pathogen: Item# Description: Qt: <br /> Dental Waste. <br /> Arnalgarrl:SizeQtyFixer:Size—Qty_Developer:Size Qty <br /> Lead:Size—QLOther:Size Qt <br /> Other:Type Size-Qt <br /> Notes: Hours NI-Ti--. 1 1`60L-5, Fn & 104 <br /> Generator Certification; I herebycertify that the contents ofthis consignmentare fully and accurately described above by proper shipping name <br /> and are classified,packed,marked,and labeled,and are in all aspects In proper candfilon for transport according to <br /> applicable government regulations. <br /> I <br /> further declare that this shipment of waste is free of hazardousand m ercury waste as defined by the US code of federal <br /> rqAj iations and/ to rules and ulations. <br /> Gen erat or(Cu sto mer) V 09 2q-j�- <br /> a-Z. = MA'A t1)&L4^jt( -- <br /> Name of authorized person(pt)/ Signature Date <br /> Route Driver 9&4id d—U4L �=l 4 <br /> Name of auth./Ized person(print! Signature 00 Date <br /> —Certificate of Destru ctlon <br /> Incineration Name of authorized/--N %person(prinj Signature Date <br /> Certificate of Destruction � <br /> Autodaved Name of authorized person(print) Signature Date <br />