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0'!08 -20 i fj <br /> Barnett Medical Services, Inc 51 Oa.429-9911 Ph Date: 95400 <br /> 3670 Enterprise Ave 510-266-0945 Fax Manifest P <br /> Hayward Ca 94545 Customer# 2232 <br /> EPA#CAL000403598 <br /> Transporter ID#4891 <br /> J., <br /> ierator: Contact: <br /> Stockton HematolocjV OrmcolotiV Stock) <br /> Frequency of Service <br /> J <br /> Pricing <br /> o Transfer Facility: M Destination Facility; f&N(ernale Transfer Facility /NeAltemate Destination Facility a DestInallon Facility <br /> Daniels SharpsmarUBMS Barnett Medical Servlces.fnc Daniels Sharpsmart 't*Urlis Bay Energy Photo Warta Recycling Inc <br /> 3670 Enterprise Ave 2385 Arch Rd#200 4144 E.Therese Ave 3200 Hawkrns,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 1569-834.6252 (410)3,54-3228 (415)459.8807 <br /> Permit A TS-125 Permit#TWOST 108 Permit#TSIOST-55 Permit#2005.WMI-0036 Permit#PWR 122764 <br /> Date— k . Dal- <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG 11 <br /> Sharps Containers Regulated Medical Waste Pharmaceutical Irace 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 /> 4gal 38 gal 9 gal 18 gal <br /> 6gal 40 gal 12 gal 20 gal <br /> 8 gal 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 /> Amalgam:Size Qty_Fixer:Size Qty Developer:SI ze_Qty <br /> lead:Size_Qt Other:Size_Qt�_ <br /> Other:Type Size—Qt <br /> Notes: <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 allaspects in proper condltlon for transport according to <br /> applicable government regulations. <br /> I fur,therpleclaie tkat this shipment of waste Is free of hazar usand er rywasteasd f db the US code of federal <br /> i7 <br /> /Iegu�t' ns djop p opri estate rules and regulatfons. <br /> Generator(Customer) A Ol O�) <br /> Nafne fif authorized person"(prhhnt) signature Date <br /> Route Driver & 0 <br /> Name of authoked person(print) signature 00 Date <br /> —Certificate of Destruction <br /> Incineration Name of authorized person(print) Signature Date <br /> f <br /> Certificate of Destruction <br /> Autoclaved Name of authorized person(print) Signature Date <br />