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Allibb, Barnett Medical Services, Inc 510-429-9911 Ph Date: <br /> IW641 3670 Enterprise Ave 510-266-0945 Fax Manifest <br /> Hayward Ca 94545 Customer# 223< <br /> EPA#CAL000403598 <br /> Transporter 10#4891 <br /> lerator: Contact: <br /> -Nolf <br /> flo,oic <br /> He-111atolou () %. - <br /> IV <br /> Frequency of Service <br /> tr(Cont <br /> Pricing <br /> o Transfer Facility. X Destination Facility: ternate Transfer Facility kAllernate Destination Facility 13 Destination Facility <br /> Daniels Sharpsmart,BIVIS Barnett Medical Services,inc; ?'-D.Iniels Sharpsmart urlis Bay Energy Photo Wasle Recycling(no <br /> 3670 Enterprise Ave 2385 Arch Rd#200 4 14 4 E.Therese Ave 3200 Hawkins Point Rd 2980 Kamer Blvd#C <br /> Hayward CA 94545 Stockton CA95216 Fresno CA 93725 Baltimore MD 21226 San Rafael CA 94901 <br /> (610)429-9911 (510)429.9911 6SM34.6252 (4110)354-3228 (415)459-8807 <br /> Permit#TS-125 Permit#TS/0ST-106 Permit#TSIOST-65 Permit#2006-WMI-0036 Permit#PWR 122764 <br /> Date <br /> Waste Collected-, UN 3291 Regulated Medical Waste n.o.s.6.2 PG 11 <br /> Sharps Containers 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 /> 4 gal 38 gal If 9gal 18 gal <br /> 6 gal 40 gal 12 gal 20 gal <br /> 8gal 44 gal 18 gal 38 gal LQ <br /> 12 gal Weight <br /> -al Size Qty Weight Product Delivered: <br /> Weight: Pathggen: 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: <br /> Generator Certification: I herebycertify that the contents of this consignment are fully and accurately described above-by propersh[pping name <br /> and are classified,packed,marked,and labeled,and are ln all aspects In proper condition for transport according to <br /> applicable government regulations. <br /> I further declare that this shipment of waste is free ofhaz do sand mercury waste as defined by the US code of federal <br /> regulations and/or /appr 7;s1ale2 rdrggul U s. <br /> OCZ11 1 <br /> 0 17 <br /> Generator(Customer) 2 14 <br /> Name of authorized person(print) f signature Date <br /> Route Driver <br /> Name of author ed person(print) 9gn'ature 00 Date <br /> "Certificate of Destruction <br /> Incineration Name of authorized person(print) signature Date <br /> Certificate of Destruction �a'1 <br /> Autodaved Name of authorized person(print) Signature Date <br />