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0 10 - <br /> Barnett Medical Services, Inc 510-429-9911 Ph Date: 12103/2013 <br /> 30620 San Antonio St51®-429-9914 FaX Manifest#: 42790 aqvil <br /> Hayward Ca 94544 Customer# 2232 <br /> EPA#CAL000331285 <br /> Transporter ID#4891 <br /> ,,...,nerator: Contact: Sally Solanki +Mork:0209)466.2626 <br /> Stockton Hemato1o(1Y-Qnocojogy weekly <br /> fifg <br /> 2626 N Carnia St,Ste#3 Frequency of Service <br /> Stockton,CA 952(A Pricing $950 a mo. <br /> n Transfer Facility: 02 Destinalion Facility: o Alternate Transfer Facility o Destination Facility o Alternate Destination Facdityo Alternate Transfer Facility <br /> Barnett Medical Services,lnc Barnett Medical Servlees,lne Heallhwlse Services Photo Waste Recycling Inc Curtis Bay Energy Daniels Sharpsmart <br /> 30820 San Antonio St 2385 Arch Rd#200 4800 E.Unealn Ave 2980 Kerner Blvd#C 3200 Hawkins Point Rd 4144 E.Therese Ave <br /> Hayward CA 94544 Stockton CA 95215 Fowler CA 93625 San Rafael CA 94901 Baltimore MD 21226 Fresno CA 93725 <br /> (510)429-9911 (510)429-9911 559-834.3333 (415)459-8807 (410)354-3228 $59.834-6252 <br /> Permit#TS-87 Permit p CTS/OST-106++ Permit#TS-89 Permit 4 PWR 122764 Pormlt#2005-WMI.0036 Permit 4 TSIOST-55 <br /> Date L Date V 13 <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG II <br /> Shar s{sCContainers Regulated 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 / ;)tJ 9 gal 18 gal <br /> 6 gal 40 gal 12 gal 20 gal <br /> 8 gal 44 gal 18 gal 38 gal <br /> gal Weight <br /> .oal Size Qty Weight Product f d• <br /> Weight: hoe Item# Description: Qt: <br /> Dental Waste: <br /> Amalgam;Size Qty Fixer:Size Qty Developer:Size Qty <br /> Lead:Slze Qt Other:Slze Qt <br /> Other:Type Size Qt <br /> Notes: Hourg: M-in 8:30-727,30 <br /> Generator Certification: i hereby certify that the contents of this constgnment are fully and accurately descrfbed above by proper shipping name <br /> and are classified,packed,marked,and labeled,and are in all aspects in propercondition for transport according to <br /> applicable government regulations. <br /> further declare that this shipment of waste Is free of hazardous and mercurywaste as defined by the US code of federal <br /> e� regulations and/or appropriate state rules and r�tin / <br /> Generator(Customer) C. ez <br /> Name of authorized person(printf Signature Dat <br /> Route Driver <br /> Name of autho zed person(print) ignature t9- <br /> Incineration <br /> t,/(, <br /> Certificate of Destruction BW 'e'4 <br /> Incineration Name of autho ized person(print) tur, Date <br /> Brett Espicha �� 12/6/2013 <br /> Certificate of Destruction <br /> Autoclaved Name of authorized person(print) Signature Date <br />