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Barnett Medical Services, Inc 510-429-9911 Ph Date: 291 <br /> 3670 Enterprise Ave 510-266-0945 Fax Manifest#: 91295 <br /> Hayward Ca 94545 Customer# 223? <br /> EPA#CAL000403598 <br /> Transporter ID#4891 Sail f i v%friric.Q09)466.2-52;5 <br /> ierator: Contact: <br /> stocyton Hematollow 0110colow - S"Oluency of Service <br /> Pricing F! -RATE <br /> ri Transfer Facility: Cil Destination Facility: Itemate Transfer Facility Alternate Destination Facility a Deslinatlon Fadlity <br /> Daniels 8barpsmart/BMS Barnett Medical Servlces,incDaniels Sharpsmart Otis Say EnergyPhoto Waste Recycling Inc <br /> 3670 Enterprise Ave 2385 Arch Rd#200 4144 E.Therese Ave 3200 Hawkins Point Rd 2980 Kerner Blvd#C <br /> Hayward CA 94645 Stockton CA 95215 Fresno CA 93725 Baltimore MD 21226 San Rafael CA 94901 <br /> (510)429.9911 (510)429-9911 569-834-6252 (410)354.3228 (415)459-8807 <br /> Permit#TS-125 Permit 9 TSIOST-106 Permit#TSIOST-55 Permit#2005-WMI-0036 Permit N PWR 122764 <br /> Date J Data <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG 11 <br /> Sharps Col3talners Regulated Medical Waste Pharmaceutical Trace Chemotherapy <br /> Size Qty: Size Qty: Wit Size Qty: Wt: Size Qty: Wit <br /> Up to: 3 gal <br /> 2 gal 20 gal 8gal <br /> 4gal 38gal 9 gal 18gal <br /> 6 gal 40gal 12 gal 20gal <br /> 8 gal 44 gal 18 gal 38 gal <br /> 12 gal Weight <br /> -al Size Qty Weight Product Delivered: <br /> Weight: Pathogen: Item# Description: Qt: <br /> Dental Waste: <br /> Arna I ga m:S I ze_Qty_Fixe r:Si ze_Qty Developer:Size_Qty— <br /> Lead:SizeQtOther:Size—Qt <br /> Other:Type Size Qt <br /> Notes- Hours H-Th 8:SG-12:3`0 11:30-5. Fr 21310-1 <br /> Generator Certification: I herebycertify that the contents of this consignment are fully and accuraM described above by proper shipping name <br /> all <br /> —W <br /> and are classified,packed,marked,and labeled,and are In at r condition for transport according to <br /> applicable government regulations. <br /> I further declare that this shipmentof waste isfree of hazardo a r rywaste as defined by the US code of federal <br /> regu lations and/or appropriate state rules and Q <br /> d u <br /> Generator(Customer) W <br /> � �Yqb <br /> Name of authorized person(print) SignatureI Date <br /> Route Driver 1;149-�-i 4a:7 3:i2,3-)b <br /> Name of auth./i zed person{print) Signature Date <br /> P> - <br /> --tertificate of Destru cti on A <br /> Incineration Name of authorized person(print) Signature Date <br /> Certificate of Destruction �12 <br /> Autoclaved Name of au Lhorized person(print) Signature Date <br />