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Barnett Medical Services, Inc 510-429-9911 Ph Date:, 07/23/2013 <br /> 306Manifest#: 37514 <br /> 20 San Antonio St 510-429-9914 Fax V 4w2232�ma QFJ Hayward Ca 94544 Customerff <br /> EPA#CAL000331285 <br /> r nerator: Transporter ID#4891 Contact: Sally Solanki 'Wont:(209)4M-2626 <br /> Stockton Hematol oqy-OnocoloQV Frequency of Service weekly <br /> 2026 N California St,Ste#3 <br /> Stockton.CA 96204 Pricing $960 a Mo. <br /> o Transfer Facility; X Destination Facility: o Alternate Transfer Facility 0 Destination Facility Alternate Destination Fac <br /> Barnett Medical Services,ine Barnett Medical Services,lnc Healthwlse Services Photo Waste Recycling Inc Xmealthcare Environmental <br /> 30620 San Antonio St 2385 Arch Rd#200 4800 E.Lincoln Ave 2980 Kerrier Blvd#C 1420 40th St NW <br /> Hayward CA 94544 Stockton CA 95215 Fowler CA 93625 San Rafael CA 94901 Fargo ND 58102 <br /> (510)429-9911 (510)429-9911 659-834-3333 (415)459-8807' (701)282-7373 <br /> Permit#TS-87 Permit#TS/OST-1106 I Permit#PWR 122764 Permit 0 ITF-208 <br /> Dat.-7 <br /> Date 6 E 1 <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG 11 <br /> Sharps Containers Regulated Medical Waste Pharmaceutical Trace ChernotherMy <br /> Size Qty: Size Qty: Wt Size Qty: Wt: S� Qty: Wt <br /> Up to: 3 gal <br /> 2 gal 20 gal 8 gal 12 gal <br /> 4 gal 38 gal 9 gal IS gal <br /> 6 gal 40 gal 12 gal 20 gal <br /> 8 gal 44 gal 18 gal 38 gal <br /> 12 gal Weight <br /> In& I Size Qty Weight Prodoct Delivered'. <br /> ,a <br /> .-.sight: Pathoizen; Item# Description: Qt: <br /> Qgntal Waste: <br /> Amalgam:Size_Qty-Fixer:Size Qty Developer:Size Qty <br /> Lead:Size-Qt- Other:Size-Qt <br /> Other:Type SizeQt <br /> Notes: M-1111:5:6u-i7:30 I 'Mtru7n 1:313-4 <br /> Generator Certification: I herebycertify that thecontents of this consignmentare fully and accurately desc dbed above by proper shipping name <br /> and are classified,packed,marked,and labeled,and are In ail aspects in properconditlon for transport according to <br /> applicable gavernmentregulations. <br /> I furthercleclare that this shipmentof waste is free of hazardou mercurywaste as defined by the US cocleof federal <br /> re @j lations and/or appropriate state rules and regulations, <br /> Generator(Customer) <br /> Name of authorized person(prQ Signature Data <br /> -d-2 -13 <br /> Route Driver — ------------ -- <br /> Name of auttofzed person(print); lure Date <br /> -ertlflcate of Destruction t ------------ ILI <br /> Incineration Name of authorized person(print) & Date <br /> Ur <br /> Brett Espicha 7/25/2013 <br /> Certificate of Destruction ——————————————— — <br /> Autoclaved Name of autho died person(print) Signature Date <br />