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hh, Barnett Medical Services, Inc 510-429-9911 'Ph Date: 03/aZi201 63 <br /> -1 - 3670 Enterprise Ave 510-266-0945 Fax Manifest#: 89942 V MLA ; <br /> 1021-Pe <br /> Hayward Ca 94545 Customer# 2232 <br /> EPA#CAL000403598 <br /> Transporter 113#4891 <br /> )orator: Contact: <br /> Stockton Hematolow Onocoloov - StI qv e e <br /> PAUency of Service <br /> N Callfo,nia-*5t,Ste <br /> F LA.T RAJ E <br /> CA -9520.4 Pricing <br /> a Transfer Facility; X Destination Facility: taTranslerFacility ftle,,nate Destination Facility o Destination Facility <br /> Daniels SharpsmaNSMS Barnett Medical Services,Inc �'=. Iri.-Sharpsmart C. s Bay Energy Photo Waste Recycling Inc <br /> 3670 Enterprise Ave 2385 Arch Rd#200 4144 E.Therese Ave 3200 Hawkins Point Rd 2980 Kamer Blvd#C <br /> Hayward CA 94545 Stockton CA 95215 Fresno CA 93725 Baltimore MD 21226 Son Meal CA 94901 <br /> (510)429-NII (510)429-9911 559-834-6252 (410)354-3228 (416)459-8807 <br /> Permit#TS-125 Permit N TSIOST-1 06 Permit#TSIOST-55 Permit#2005-WMI-0036 Permit#PWR 122764 <br /> 0 - <br /> Date �Ac <br /> Waste Collected; LIN 3291 Regulated Medical Waste n.o.s.6.2 PG 11 <br /> Sharps Contalners Regulated Medical Waste Pharmaceutical Trace Chemotherapy <br /> Size Qty: Size Qty: Wt Size Qty: Wt-. Size Si QW, <br /> Wt <br /> Up to: 3 gal <br /> 2 gal 20gal 8 gal 12 gal <br /> 4gal 38gal ZD 9 gal 18 gal <br /> 6 gal 40 gal 12 gal 20 gal <br /> 8 gal 44 gal 18 gal 38 gal <br /> 12 gal Weight <br /> ,al Size Qty Weight Product Delivered: <br /> Weight: Pathogen: Item 4 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 8:30-12:30 1 ':-310-6. Fri 8:30-4 <br /> Generator Certification: I heretrycertify that the contents of this oDnsignmentare fully and accuratejydesrribed 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. I <br /> I further declare that this shipmentof waste is free of hjWa�rdsand mercurywaste ned by the US code of federal <br /> regulations and/or appropriatestate rules and <br /> Generator(Customer) Z&A u",/, %Y�� <br /> Name of authorized person(print) Signature Date <br /> Route Driver <br /> Name of author ed person(print) Signature Date <br /> `,Certlfkate of Destruction <br /> Incineration Name of authorized person(print) Signature Date <br /> Certificate of Destruction aARQN �:�ch % mr,a P&J I I <br /> Autodaved Name of au tho dzed person(print) Signature Date <br />