Laserfiche WebLink
Barnett Medical Services, Inc 510-429-9911 Ph Date: <br /> 3670 Enterprise Ave 510-266-Q945 Fax Manifest#: 13 <br /> Hayward Ca 94545 Customer# 2232 <br /> EPA#CAL000403598 <br /> Transporter 10#4891 ry, Z.71 46F LF <br /> ierator: Contact: <br /> Stockton "ematoloov onocoloqfv - st <br /> uency of Service <br /> j626!`I -;34rm a-,Sr.S'e#-1 F L.kT R,',.7E <br /> Pricing <br /> Su. CA. <br /> o TransferFadlity: 01 Destination Facility: V Alternate Transfer Facility WARemale Destination Facility 3 Oe,llnaffon Facility <br /> Photo Waste Recycling Inc <br /> Daniels ShafpsmarVBMS Barnett Medical Services,inc Daniels Shafpsmart VNCurtls Bay Energy 2980 Kamer Blvd#C <br /> 3670 Enterprise Ave 2385 Arch Rd#200 4144 E.Therese Ave 3200 Hawkins Point Rd San Rafael CA9490i <br /> Hayward CA 9454 5 Stockton CA 95215 Fresno CA 93725 Baltimore MD 21226 (416)459-8807 <br /> (510)429-9911 (510)429-9911 559.834-6252 (410)354-3228 <br /> Permit#TS-125 Permit#TSIOST-106 Permit#TSIOST-55 Parmlt#2005-WMI-0036 Permit#PWR 122764 <br /> Date Dale' <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PIS 11 <br /> Sharps Containers Regulated Medical Waste Pharmaceutical Trace Chemotherap <br /> Size Qty: Size Qty: Wt Size Qty: Wt: Size Qty: Wt <br /> Up to: 3 gal <br /> 2 gal 20 gal 8 gal 12 gal <br /> 4 gal 38gal 9 gal 18gal <br /> 6 gal 40 gal 12 gal 20 gal <br /> 8 gal 44 gal 18gal 38gal <br /> 12 gal Weight <br /> ,al Size Qty Weight Product Delivered: <br /> Weight: Pathogen: Item# Description: Qt: <br /> Dental Waste: <br /> Arna Iga m:Size-Qty-F1 xer:Size_Qty_Devel ope r:Size_Qty <br /> Lead:SizeQtOther:Size Qt�__ <br /> Other:Type Size—Qt <br /> Notes- Haurs h&Tn� 9:if;-1 2:-30 1 1 37`1--)-a <br /> Generator Certification: I hereby certifyt1allee nte,.t.,dofthis,,,r�,ignment are fully and accurately described above by proper shipping name <br /> C9 <br /> rn�r <br /> and classified, labeled,and are In all aspects In proper condition for transport according to <br /> afpTt*e govern r*nt/egula dons. <br /> I r er d are t his shipment of waste is free of hazardous and mercurywaste as defined by the US code of federal <br /> re tat ns nd/or ppropriatestate rules alations. <br /> Generator(Customer) 17 �Yo U9&0- 3-3 <br /> N autho,>ildp rson I h Signatureure Date <br /> Route Driver S—3 <br /> Date <br /> —Certificate of Destruction Name of auth�lzecl person(print) Signature <br /> Incineration Name of authorized person(print) Signature Date <br /> �✓�,� <br /> Certificate of Destruction 2:)cNaecy\of SL P4 ix. <br /> Autoclaved Name of authorized person(print) Signature Date <br />