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8 8 <br /> Barnett Medical Services, Inc 510-429-9911 Ph Date: 13 6/2 <br /> 3670 Enterprise Ave 510-266-0945 Fax Manifest M 9€'73R- <br /> Hayward Ca 94545 Customer# 2232 <br /> EPA#CALOOD403698 <br /> Transporter ID#4891 <br /> ierator: Contact: <br /> Stockton Hennatolocivi Onocoloiciv - Stffs�ency of Service <br /> 2,52N St,-�?e K., <br /> -AT R'a6TE <br /> Pricing <br /> a Transfer Facility: Of Destination Fs6lity. tomato Transfer Facility Alternate Destinallon Facility a Destination Facility <br /> Denials Sherpsmart/BMS Barnett Medical Serilcesjnc Vla[als Sharpsmart Kurds Bay Energy Photo Waste Recycling Inc <br /> 3670 Enterprise Ave 2385 Arch Rd 9200 4144 E.Therese Ave 3200 Hawkins Point Rd 2980 Kamer Blvd NC <br /> Hayward CA 94545 Stockton CA 95215 Fresno CA 93725 Baltimore MD 21226 Son Rafael CA 94901 <br /> (510)429.9911 (610)429.9911 659-834-6252 (410)354-3228 (415)459-8807 <br /> Perrnft#TS-125 per 4 S10ST'I Permit#TS/OST-55 Permit 2005-WMI-0036 Permit N PWR 122764 <br /> Date- DatejM9//,6 <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s, 5.2 PIS If <br /> Sharps Containers Regulated Medical Waste Pharmaceutical Trace Chemptherapy <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 12gal 20 gal <br /> 8gal 44 gal 18 gal 38 gal ID <br /> 12 gal Weight <br /> -a[ Size Qty Weight Product Delivered; <br /> Weight: Pathogen: Item# Description: Qt: <br /> PMtal Waste: <br /> Amalgam;Size_Qty_Fixer:Size_Qty_Developer:Size_Qty <br /> - <br /> Lead:Size_Qt_ Other:Size_Qt�___ <br /> Other:Type SizeQt <br /> Notes: kou!-s M-Tr.-&'201-12.210 1 1:30-5)t Vn 0 30-4 <br /> Generator Certification: I hereby certify that the contents of this conslgnm ant are fully and accurately described a)ove by proper shipping name <br /> and are classified,packed, and labeled,and are in allaspects In proper condition for transport according to <br /> applicable government re ulations. <br /> 'I further declare thattlils shipment of waste Is free ofha rd usa ryvva fined by the US code of federal <br /> reguhtlons an or appronriatestate les and r ad s. <br /> Generator(Customer) <br /> Name of authorized person(print) Signature U Date <br /> Route Driver 44 1ka7 ��- <br /> Name-of auth Ized person(print) Signature 7,A Date <br /> ',:-Certificate of Destruction <br /> Incineration Name of authorized person(print) Slinature Date <br /> Cerifficate of Destruction art 612olleo <br /> Autoclaved Name of authorized person(print) Signature Date <br />