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Barnett Medical Services, Inc 510-429-9911 Ph Date: 04/061201C, <br /> 3670 Enterprise Ave 510-266-0945 Fax Manifest <br /> Hayward Ca 94545 Customer# 2232 <br /> EPA#CALOD0403698 <br /> Transporter IDN4891 I <br /> aerator: Contact: <br /> Stockton Hematolociv Onocojr-,qV St%. i <br /> 41.1ency of Service <br /> Pricing FLAT PAVTE <br /> a Transfer Facility: 01 Oeslinalion Facility. V,Alternate Transfer Facility befftrnattl Destination Facility a Destination Facility <br /> Daniels SharpsmarVBMS Barnett Medical Services3no Nnials Sharparnert f —Quirlis Bay Energy Photo Waste Recycling Inc <br /> 3670 Enterprise Ave 2385 Arch Rd M0 4144 E.Therese Ave 3200 Hawkins Point Rd 2980 Kerner Blvd#C <br /> Hayward CA 94545 Stockton CA 95215 Fresno CA 93725 Baltimore MD 21226 Son Rafael CA 94901 <br /> (510)429.9911 (610)429-9911 659.834-6262 (410)354-3228 (415)45MS07 <br /> Permit#TS-125 Permit#TSIOST-106 I Permit 9 MOST-55 Permit 0 2005-WMI.0036 Permit#PWR 122764 <br /> Date _Date <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6,2 PG 11 <br /> Sharps Containers Regulated Medical Waste Pharmaceutical Trace Chemotherapy <br /> Size Qty: Size Qty: Wt Size Qty: Wt: Size Qty: Wt <br /> Up to: 3gal <br /> 2 gal 20 gal 8 gal 12 gal <br /> 4gal 38 gal 'ZA:) 9 gal 18gal <br /> i5gal 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# Description: Qt: <br /> Dental Waste: <br /> Amalgam:Size Qty Fixer:Stze_Qty_Developer:Size Qty <br /> Lead:Size_Qt� Other:Size_Qt_ <br /> Other:Type Size—Qt <br /> Notes: HoUrS M-Tl-,C-20-12.33,0 ' 1:331-P:, Fri <br /> Generator Certification: I herebycertify that the contents of this consignment are fully and accurately described above by proper shipping name <br /> and are classified,packed,marked,and labeled,and are Inall aspects in proper condition For transport according to <br /> applicable government regulations. <br /> I further declare that this shipmentof waste Is free of azard s dmercury wa as defined by the US code of federal <br /> rpulatfons and/or jp (opriatestate rules and I ons. <br /> Generator(Customer) Poll V, fjali.-4e ql6h(,c <br /> Name of authorized ' 0 IF Signaore —Date <br /> Route Driver AL aX� 4/MX <br /> Name of aulrized person(print) 9 g n a t u�r* Date <br /> '-Certificate of Destruction <br /> Incineration Name of authorized person(print) SignatureDate <br /> Certificate of Destruction _qml:��N�: 10.�) Am� "09L <br /> Autodaved Name of authorized person(print) Signature Date <br />