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Barnett Medical Services, Inc 510-429-9911 Ph Date: 1'`'"6,12,1 113 <br /> TA 3 <br /> N, 3670 Enterprise Ave 510-266-0945 Fax Manifest#: 96515 <br /> IDD O Hayward Ca 94545 Customerft 2'2==$ <br /> EPANCAL000403598 <br /> Transporter ID#48916 -166-252: <br /> Aerator. Contact: <br /> Stockton Hpinatolociv Onocolociv - Rpm <br /> Frequency of Service <br /> H—RTR. TE <br /> Pricing <br /> a Transfer Facility: Dill Destination Facility, teale Transfer Facility Alternate Destination Facility 0 Destnallon Facility <br /> Daniels Sharpsmart/BMS Barnett Medical Servlces,lnc t)!�Darnnlels Shoipsmart urVa Bay Energy Photo WasteRecycling Inc <br /> 3670 Enterprise Ave 2385 Arch Rd#200 4144 E.Therese Ave 3200 Hawkins Point Rd 2980 Kernel Blvd#C <br /> Hayward CA 94545 Slochton CA95215 Fresno CA 93725 Baltimore MD 21226 San Rafael CA 94901 <br /> (510)429-9911 (510)429.9911 559.834-6252 (410)354-3226 (415)45"07 <br /> Permit#TS-125 Permit#TS/OST 106 Permit N TS/OST-55 Permit#2005-WMI-0036 Permit N PWR 122764 <br /> Dale --Data <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG 11 <br /> SharRs Cgntalner$ Regulated Medical Wase 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 8gal 12gal <br /> 4gal 38 gal __L_ ZD 9 gal 18 gal <br /> 6 gal 40 gal 12 gal 20 gal <br /> 8gal 44 gal 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:Size_Qty_ <br /> Lead:Size—Qt Other:Size—Qt <br /> Other:Type Size_Qt�_ <br /> 3-'A-3 <br /> Notes: Fri �61- <br /> Generator Certification: I herebycertIfy that the contents of this consIgnmentare fully and accurately described above by proper shipping name <br /> and are classlfled,packed marked,and labeled,and are in all aspects In proper condition for transport according to <br /> applicable government regulations. <br /> I further declare thatthis shipmentof I Ir of usand mercurywaste d ined by the US code of federal <br /> re ns Vndd 0 'Zind <br /> 7/ pri estate 7ru <br /> Generator(Customer) �'0_2 " .. (P-;'�-1 1� <br /> Name of authorized person(prin Date <br /> Y, <br /> Route Driver Aq';�Z- Signature (P-').4-—/(0— <br /> Name of aut ItrIzed person(prin* Signature Dy Date <br /> —Certificate of Destruction <br /> Incineration Name of authorized person(print) Signature Date <br /> Q\ <br /> Certificate of Destruction , ') <br /> zpkciv\ <br /> % �03A <br /> Autodaved Name of au thicirized person(print) Signature Date <br />