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Barnett Medical Services, Inc 51G-42-9-9911 Ph Date: NjV/2016 <br /> 3670 Enterprise Ave510-266-0945 Fax Manifest 4: 920-53 <br /> Hayward Ca 94545 Customer# 2232 <br /> EPA#CALOOD403598 <br /> Transporter ID#4891 <br /> --lerator: Contact: Soli/Solank" 'NOTIV CKS)0, 2t26 <br /> Stockton HernatoloqV or-jocolo(W St_�-;cl�, weekly,-4162E N Calffomia St.Ste*3 Frequency of service <br /> --to^ktr ,—A <br /> 115204 Pricing FLAT RAT <br /> 0 Transfer Facliftf. X Destination Facility: Alternate Transfer Facility &Alternate Destination Facility o DeeUrlation Facility <br /> Daniels SharpsmarMS Barnett Medical Servlces.inc f Dartlels Sharpsmart <br /> 3670 Enterprise Ave urns Say Energy Photo Waste Recycling Inc <br /> 2385 Arch Rd#200 4144 E.Therese Ave 3200 Hawkins Point Rd 2980 Kerner aw#c <br /> Hayward CA 94545 Stockton CA 95215 Fresno CA 93725 Baltimore MD 21226 San Rafael CA 94901 <br /> (510)429-9911 (510)429-9911 559-634-6252 (410)354-3228 (416)459-8807 <br /> Parmit#TS-125 Permft#Ts/0ST-106 Permit#TWOST_% PerrNI#2005-WMI-0036 Pennit#PWR 122764 <br /> Date- oat <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG 11 <br /> 5w gontainem &ULated IV�edical Waste Pharmaceutical Trace Chemotherap <br /> Sfze Qty: Size Qty: Wt Size Qty: Wt: Size Qty: Wt <br /> Up to: 3 gal <br /> 2 gal 20 gal 8 gal gal _ <br /> 4 gal 38 gal --L— JO- 9 gal 18 gal <br /> 6 gal 410gal 12 gal 20 gal <br /> 8 gal 44 gal 18 gal 38 gal <br /> 12 gal Weight <br /> mal Size Qty Weight Product QgjNg&A- <br /> Item# Description: Qt: <br /> Denjgl <br /> Amalgam:Slze_CLty_Fixer:Size_Qty Developer;Size Qty <br /> Lead:Slze_QtOther:Size_Qt�__ <br /> Other:Type Size Qt <br /> Notes: Hours-P-Th 8:-30-1 j: G 1, 11:31J-5% Fri 8-..,730�-4 <br /> Generator Certification: I herelyycertity that the contents of this cDnsignm ant are fully and accurately described above by proper shipping name <br /> and are classiffed,packed,marked,and labeled,and are In all aspects in proper condition for transport according to <br /> applicable government regulations. <br /> I further dedare that this shipmentofwaste Is free of hazar sand mercury Waste as d iryedby the US code of federal <br /> rel as and/or ap priatestate rules and regulation <br /> Me, <br /> Generator" <br /> , Z—� <br /> dperson <br /> r.(pl. <br /> Name of authorized person t) Signature Date <br /> Route Driver Ll <br /> Na*m.eofauthorl d person(print) SIgnature Date <br /> wtifficate of Destruction <br /> Incineration Narne of authorized person(print) Signature Date <br /> Certificate of Destrij coon - 1q <br /> I6 <br /> Autodave.d Name ofauthoilud Person(print)' LL=�) C\ q <br /> Signature d Date <br />