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Barnett Medical Services, Inc 510429-9911 Ph Date., [16-0 <br /> IM <br /> 04 44 3670 Enterprise Ave 510-266-0945 Fax Manifest#: 9j5]#q1:10Hayward Ca 94545 Customer# 2232 <br /> EPA#CAL000403598 <br /> Transporter ID#46911 <br /> ierator: Contact: <br /> Stockton Hemiatoloqv Onocolocly - Sti%'ql2ency of Service <br /> Pricing <br /> o Transfer Facility; M Destination Facility: -1 Alternateoato Tron5rerFacigty Alternate Destination Facility aDeolination Facility <br /> Danlals SharpsmatVBMS Barnett Medical Services,1no Daniels Sharpsmart v-,Surila Bay Energy Photo Waste Recycling Inc <br /> 3670 Enterprise Ave 2385 Arch Rd#200 4144 E.Therese Ave 3200 Hawkins Point Rd 2980 Kerner Blvd#C <br /> Hayward CA 94545 Stockton CA 95216 Fresno CA 93725 BalUmoro MD 21226 Son Rafael CA 94901 <br /> (510)429-9911 (510)429.9911 559-834-6252 (410)364-3228 (416)459-8807 <br /> Permit 4 TSA25 Permit#TSIOST-1106 Permit#TSIOST-65 Permit#2005-WMI-0038 Permit#PWR 122764 <br /> Date �0 <br /> -26:nh--Dale��l <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG 11 <br /> Sharps Containers Regulated Medical Waste Pharmaceutical Trace Chemotherap <br /> Size Qty: Size Qty: Wt Size Qty: Wt: Size Qty: wt <br /> Up to: 3 gal <br /> 2 gal 20 gal 8gal 12gal <br /> 4 gal 38 gal Z GCS 9 gal 18 gal <br /> 6 gal 40 gal 12 gal 20 gal <br /> 8gal 44gal 18 gal 38 gal <br /> 12 gal Weight <br /> -al Size Qty Weight Product Delivered: <br /> Weight: Pathogen: Item# Description: Qt: <br /> Dental Waste: <br /> Ama Iga rn!Size_Qty-Fixer;Size City Devel o pe r:SI ze-Qty_ <br /> Lead:Slze_Qt_ Other-.Size-Qt <br /> Other:Type Size Qt <br /> Notes: 1L-.C-L;rs )A-7h :3-730-''�-30 1 1, Ff�j Eq:31-.-A <br /> Generator Certification: I hereby certify that the contents of this consignm entare fully and accurately described above by proper sh[pping name <br /> and are classified,packed,marked,and labeled,and are in all e is in proper condition fo sport according to <br /> applicable government regulations. <br /> I further declare that this shipmentof waste Is free of h ardaus nd ar ry a e. d In by 5 code of federal <br /> re lation7d/ appropriatestatt rules and r ula- ns. <br /> Generator(Customer) <br /> Rr.e*2fT.th.rIzZ pesff(`prff Fignature Date <br /> Route Driver f�64T4 MOn4(�L --�Z) (0 -)- <br /> - Name of auttiorized person(print) Ydgnature,) Date <br /> -Certificate of Destruction <br /> Incineration Name of authorized person(print) Signature Date <br /> Certificate of Destruction <br /> Autodaved Name of authorized person(print) Signature Date <br />