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Barnett Medical Services, Inc 510-429-9911 Ph Date, 0='114:21316 <br /> 3670 Enterprise Ave 510-266-0945 Fax Manifest 93287 <br /> Hayward Ca 94545 Customer# 2232 <br /> EPA#CAL000403598 <br /> ierator: Transporter ID#4891 Contact: E714 <br /> SC'13-1kj V-.V� r26�)456-2ED7 <br /> Stockton Hernatolow Onocolom - S <br /> Contact: <br /> of Service <br /> RAT- <br /> F LAT LZ <br /> Pricing <br /> a Transfer Facility: Qt Destination Facility: )�Alternate Transfer Facility /Alternate Destination Facility a Destination Facility <br /> Daniels SharpsmarttBMS Barnett Medical Services,ino Mnle;s Sharpsmad _,SrUs Bay Energy Photo Waste Recycling Inc <br /> 3670 EnlerpriseAve 2385 Arch Rd#20o 4144 E.Therese Ave 32DO Hawkins Point Rd 2980 Kamer Blvd#C <br /> Hayward CA 94546 Stockton CA 95215 Fresno CA 93725 Baltimore MD 21226 San Rafael CA 94901 <br /> (510)429.9911 (510)429-9911 559-834-6252 (410)354-3228 (415)459-8807 <br /> Permit#TS425 Parrnit#TSIOST-106 Permit 4 TS/OST-55 Permit#2005-WM 1-0036 Permit#PWR 122764 <br /> Data— -Dalo wo <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.S.6.2 PG 11 <br /> Sharps Containers Regulated Medical Waste Pharmaceutical Trace Cherricitherapy <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 ga I <br /> 4 gal 38 gal Z. -Z0 9gal 18 gal <br /> 6 gal 40 gal 12 gal 20 gal <br /> 8 gal 44 gal 18 gal 38 gal 7V' <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:Size_QtV_Developer:Size_Qty_ <br /> Lead:Slze_Qt_ Other:Size Qt <br /> Other:Type— Size—Qt— <br /> Notes. Host's NI-TF. 8:30-12-30 ! 1:31C E. Fr: E;30-1 <br /> Generator Certification: I hereby certify that the contents of this consignment are fully and accurately described above by proper shlppingname <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 t a�this shIpmentofwaste is free Aofaza du, rid�71�/sttf tried the US code of federal <br /> tj ris a)d/. a pro latestate les and r ons. <br /> I _ 11t4 SV Y .0 <br /> Generator(Customer) ;b, 0� TA, 71, <br /> Name of authorized person 1print} 7 Signature Date <br /> R"e Driver NQ4V AoAh Z S-- <br /> Name of aufrized person(print) 51gnature Date <br /> Certificate of Destruction <br /> Incineration Name of authorized person(print) Signature Da e <br /> Certificate of Destrud on 269,� QnrZI'0faVJ %kA510 <br /> Autoclaved Name of authorized person(print) Signature Date <br />