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0 #0 <br /> Barnett Medical Services, Inc 510-429-9911 Ph Date, 0,",/0&2016 <br /> 1 <br /> mpv3670 Enterprise Ave 510-266-0945 Fax Manifest 1 " Hayward Ca 94545 Customer# 2232 <br /> EPA#CAL000403598 <br /> Transporter 10#4891 <br /> ierator: Contact: 3c.'zinki xcee': (;ter?)"__ <br /> Stockton Hematolow Onocolow -Stprs i -..,-YeekV <br /> Nency of Service <br /> 25215 N'"-3(If�jcpi3 St, #3 <br /> C" FLA I RATE <br /> ::4ock-mri,*-11 9120' Pricing <br /> o Transfer Facial. M Destination Facility: tjf_Allemate Transfer Facility OQUIernate Dostination Facility in Dest[naflon Facility <br /> Daniels SharpsmartfBMS Barnett Medical Services,inc 7' 0-aniols Sharpsmart rtfs Bay Energy Photo Waste Recyding Inc <br /> 3670 Enterprise Ave 2385 Arch Rd#200 4144 E.Therese Ave 32DO Hawkins Point Rd 2980 Kamer Blvd#C <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 (415)09-8807 <br /> Permit#TS-125 Permit#TSIOEST-106 Permit 9 TSIOST-55 Permit#2005-WMI-0036 Perrnit#PWR 1122764 <br /> Data_ Date^ <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG 11 <br /> Sharps Cqntalners Regulated Medical Waste Pharmaceutical Trace Chemotherapy <br /> Size Qty: Size Wt Size Qty: Wt: Size Qty: Wt <br /> Up to: 3 gal <br /> 2 gal 20 gal 8gal 12 gal <br /> 4 gal 38 gal Z- Z� 9gal 18gal <br /> 6 gal 40gal 12 gal 20gal <br /> 8 gal 44 gal 18 gal 38 gal L <br /> 12 gal Weight <br /> al Size Qty Weight Product Delivered: <br /> Weight; Pathogen: Item H Description: Qt'. <br /> Dental Waste; <br /> Amalgam:Size My Fixer:Size Qty_Developer:Size_Qty <br /> - <br /> Lead:Size Qt;- Other:Size Qt <br /> Other;Type —Size—Qt <br /> Notes: Ho--srs V-1 h S:30-12:x0 1 1:30-5, Frii 8:2-0-41 <br /> Generator Certification: I herebycertify that the contents of this consignment are hilly and accurately described above by proper shipping narne <br /> and are classified,packed,marked,and labeled,and are ln 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 hazardousand mercurywaste as defined by the US code of federal <br /> regulations and/or appropriate state rules and regulations. <br /> Generator(Customer) 50^/c, j <br /> Name of authorized person(prirtt) Signature Date <br /> Route Driver A� 44 4?- . -3/9. <br /> Name of a4-rlzed person(print) Signature Date <br /> 'Certificate of Destruction <br /> Incineration Name of authorized person(print) Signature Date <br /> Certificate of Destruction JLMl ,) R.Q�� %22A <br /> Autoclaved Name of authorized person(print) Signature Date <br />