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ZBarnett Medical Services, Inc 510-429-9911 Ph Date-, 92343 <br /> I <br /> 3670 Enterprise Ave 510-266-0945 Fax Manifest#:IP Hayward Ca 94545 Customer# 2232 <br /> EPA#CAL000403598 <br /> Transporter IDW91 S—I!v c <br /> ierator: Contact: lfsr -i -AJcrw:!209,A--A-2E--.6 <br /> Stockton Hematoloqv ono('olocjV -.stpc.kl <br /> I-E28 I] requency of Service <br /> -togiAton'C' Pricing FLAT RA'j7.-- <br /> o Transfer Facility: 04 Destination Facility: 4-41 le Transfer Facility P(Altemate Destination Facility a Destination Facility <br /> Barnell Medical Services,lncle <br /> Photo Waste Recycling Inc <br /> Danlels SharpsmaMBMS Daniels Sharpsmarl Curtis Bay Energy <br /> 3670 Enterprise Ave 2385 Arch Rd#200 4144 E.Therese Ave 3200 Hawkins Point Rd 2980 Kemar Blvd NG <br /> Hayward CA 94645 Stockton CA 95215 Fresno CA 93725 Baltimore MD 21226 San Rafael CA 94901 <br /> (510)429-9911 (510)429-9911 659-834-6252 (00)364-3228 (415)459-8807 <br /> Permit#TS-125 Permit N TSIOST-106 Permit#TSIOST-55 Permit#2005-WMI-0038 Permit#PWR 122764 <br /> Data J-IZN— Datl W6 <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG 11 <br /> Sharps Containers &Kulated 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 /> 4 gal 38 gal 10 — 9 gal 18 gal <br /> 6 gal 40 gal 12 gal 20gal <br /> 8 gal 44 gal 18 gal 38 gal <br /> 12 gal Weight <br /> .al Size Qty We light Product Delivered: <br /> Weight: Pathogen: Item# Description; Qt: <br /> Dental Waste: <br /> Amalgam:Size_Qty—Fixer:Size Qty Developer:Size Qty <br /> Lead:Size_Qt Other:Size Qt <br /> Other:Type — Size Qt <br /> Notes: )-toiref4-Th,8:30-12�.3-0 i -1:30-5, IPri 8:30-3 <br /> Generator Certification: I herebycertify that the contents of this consignment are fully and accurately clescrl bed above by proper shipping name <br /> and are classified,packed,marked,and labeled,and are in 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 hpaqIousand mercury waste as defined by the US code of federal <br /> regu lations and/or appropriate state rules and 14gulaon s.\ <br /> Generator(Customer) CAA C' &VVx/ cy)"k�—) <br /> Name of authorized person(print) Signa ure Date <br /> 1, q <br /> Route Driver N <br /> o <br /> -of- <br /> Nhme of a-9- zed person(print) Signature Date <br /> --Certificate of Destruction <br /> Incineration Name of authorized person(print) Signature Date <br /> Certificate of Destruction <br /> CAjAz. <br /> a <br /> Autodaved Name of authorized person(print) Signature Date <br />