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Barnett Medical Services, Inc 510-429-9911 Ph Date: <br /> 1 <br /> Z1p� 44 3670 Enterprise Ave 510-266-0945 Fax Manifest#: 93842IN Hayward Ca 94545 Customer# 22-32 <br /> EPA#CAL000403598 <br /> Transporter IMM891 <br /> ierator: Contact: <br /> StocYton Hematojoqy 0Eoc.,pjoq,i <br /> -.5 alit -a -.1: ----?om P Nq-uency of Service <br /> Pricing <br /> n Transfer Facility: Ml Destination Facility: Des <br /> a Destination Facility <br /> Daniels Sharpsma"MS 4Daniels Sharpsmart--Wrnate Transfer Facility 4AJI. <br /> Barnett Medical Servicooric V at Destination Facility Waste Recycling Inc <br /> 3670 Enterprise Ave Bay Energy Photo Was <br /> 2385 Arch Rd#200 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 San Rafael CA 94901 <br /> (510)429-9911 (510)429-9911 559-834-6252 (4110)354-3228 (416)459-0807 <br /> Permit#TS-125 Permit#TSIOST-106 Permit#TS/OST-65 Permit#2005-WMI-OD36 Permit 9 PWR 122764 <br /> Date Dale 11 <br /> Waste Collected: LIN 3291 Regulated Medical Waste n,o.s.6.2PG 11 <br /> Sharps Containers Regul ted 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 -Z,0 9gal 18 gal <br /> 6 gal 40 gal 12 gal 20 gal <br /> 8gal 44 gal 18 gal <br /> 38 gal <br /> 12 gal Weight <br /> A Size Qty Weight Product Delivered: <br /> Weight: Pathogen: Item# Description: Qt: <br /> Dotal Waste: <br /> Annalga m:Size-Qty_Fixer:Size-Qty_Developer:Site Qty_ <br /> Lead:Size-Qt Other:Size-Qt <br /> Other:Type Size Qt <br /> Notes: !O-Tl-i 9W-'!2iSID s - <br /> Generator Certification: I hereby certify 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 In all aspects in proper condition for transport according to <br /> applicable government regulations. <br /> furtherIdeda re that this shipment 2��asw is free of ha r ousa drnercurywast de'ned by the US code of federal <br /> Cationspp priates a as and at s <br /> Generator(Customer) A� 17 7, 794 X-A X, - <br /> Name of authorized person(priji Signature Date <br /> Route Driver dA:� <br /> Name ofauthqri d person(print) Signature Date <br /> Certificate of Destruction <br /> Incineration Name of authorized person(print) Signature Date <br /> Certificate of Destruction <br /> Autoclaved Name ofauthodzed person(pr'Int) Signature Date <br />