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Barnett Medical Services, Inc 510-429-9911 Ph Date: 0 4.;13;2'0 1 6i <br /> 3670 Enterprise Ave 510-266-0945 Fax Manifest M 92342 <br /> Hayward Ca. 94545 Customer# 2232 <br /> EPANCAL000403698 <br /> Transporter ID94894 4i5-5-*2!7.K- <br /> ierator: Contact: <br /> Stockton Hpinatolo(liv Onocolociv -StPrC6qhulency of S -eek y <br /> ervice <br /> 262115,N'l.-.4ifornia St,�re WS; <br /> FLAX RATE <br /> -r�xor-. Pricing <br /> r) Transfer Facility: C9 Destination Facility: o Alternate Transfer Facility n Alternate Destination Facility ci Destination Facility <br /> Denials SherpsmarUSMS Barnett Medical Services,fine Daniels Sharpsmart Curbs Bay Energy Photo Waste Recycling Inc <br /> 3670 Enterprise Ave 2385 Arch Rd#2130 4144 E.Therese Ave 3200 Hawkins Point Rd 2980 Kamer Blvd sic <br /> Hayward CA 94545 Stockton CA 95215 Fresno CA 93725 Baltimore MID 21226 Sari Rafael CA94901 <br /> - -834-6252 -3228 (415)459-8807 <br /> (510)429 9911 (510)429-9911 559 (410)354 <br /> Permit#TS-125 Parrnit 11 TSIOST-106 Permit#TSIOST-55 Permit 9 2005-WMI-0036 Permit#PWR 122764 <br /> 1 <br /> Date DateW. / <br /> 6 <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG 11 <br /> Sharps Container] Regulated Medical Waste Pharmaceutical Trace Chemotherapy <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 /> 4gal 38 gal 9 gal 18 gal <br /> 6gal 40 gal 12 gal 20gal <br /> 8gal 44 gal 18 gal 38 gal <br /> 12 gal Weight —TE7 <br /> ,,a I Size Qty Weight Product Delivered: <br /> Weight: Nabogem: Item# Description: Qt: <br /> Dental Waste, <br /> Anna I ga m.S!ze Qty—Fixe r:Size Qty Developer:Size_Qty_ <br /> Lead:Size—Qt Other:Size—Qt <br /> Other:Type Size—Qt <br /> Notes: HOUrS M-1 17 8:','U-12=! Fri 8:3LI66 <br /> Generator Certification: I herchycertity that the contents of this consignment are fully and accurately described above by proper shlpping name <br /> and are classified,packed,marked,and labeled,and are in ail aspects in proper condition for transport according to <br /> applicable government regulations. <br /> I further declare that this shipmentof waste Is free of hazardou sand mercurywas y the US code of federal <br /> regulations and/or app,oprla,L,t;,te rule,andpulations, <br /> �AA' J_ — <br /> eE 'IV <br /> Generator(Customer) L n A&I C <br /> e of authorized person pr 9 Cure Udtt! <br /> Route Driver <br /> Nam of authorized lirson(print) —Signature� Date <br /> Certlficate of Destruction <br /> Incineration Name of authorized person(prinq Signature Date <br /> Certificate of Destruction Ilia )1(0 <br /> Autodaved Name ofauthorlzed person(print) Signature Date <br />