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Barnett Medical Services, Inc -510-429-9911 Ph Date: Cr"20i t <br /> 3670 Enterprise Ave 510-266-0945 Fax Manifest#: !J54,01 <br /> Hayward Ca 94545 Customer# 2232 <br /> EPA#CAL000403598 <br /> Transporter ID#4891 <br /> erator: Contact: SA _KF' <br /> Stocktort Hernatolociv onocoicicIv s <br /> 'PrOuency of Service <br /> �7 <br /> Pricing <br /> a Transfer Facility; C4 Destination Facility: z4A—temate Transfer Fadlity, dlity o Destination Fadlity, <br /> Da Barnett Medical Soirvices,inc. Daniels Sharpsmart 'ema'e DO."na Photo Waste Recyding Inc <br /> Outs SharpsmartIBIVIS 4144 E,Therese Ave ni.Bay Energy <br /> 70 Enterprise Ave u 'J'ina P� 2980 Kerner Blvd NC <br /> 2385 Arch Rd#200 0�200 H. int RFda <br /> Hayward CA 94545 Stockton CA 95215 Fresno CA 93725 Baltimore IVID 21226 Son Rafael CA 94901 <br /> (510)429.9911 (610)429-9911 569-834.6252 (410)364-3228 (415)459-8807 <br /> Permit#TS-125 P It#TS 0ST-106 Permit#TS/OST-55 Permit#2005-WMI-0036 Permit#PWR 122764 <br /> Date— :E ow-W16 <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PIS 11 <br /> Sharm Containers Bggulatecl 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 9 gal 18 gal <br /> 6 gal 40 gal 12 gal 20 gal <br /> 8 gal 44 gal 18 gal 38 gal 7. Zo <br /> 12 gal Weight <br /> '81 Size Qty Weight Product Delivered: <br /> v,.-eight: Pathogen: 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: S3 4 <br /> Generator Certification: I herebycertffy ftt the contents of this consiginmentare fully and accurately described above-by proper shipping name <br /> and are classified,packed marked, <br /> r�cl,and labeled,anclare ln all aspects in proper condition for transport according to <br /> applicable government regulations... <br /> sh ent of waste Is free of hazardous and mercury waste as defined by the US code of federal <br /> estat rules andregu <br /> Generator(Customer) %a tv /,S--I (' <br /> Name ollauthorized person( rin Signature Date <br /> Route Driver 6"- 7— (0-115-j G <br /> Name of authors ed person(print) Signature 00 Date <br /> —iertlflcate of Destruction <br /> Incineration Name of authorized person(print) Signature Date <br /> Certificate of Destruction -SANP,QQV\ oc�DA nN 6/16 (0 <br /> Autodaved Name of authorized person(print) Signature Y Date <br />