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Barnett Medical Services, Inc 510-429-9911 Ph Date: 12/1012013 <br /> I MON ;/ ' 30620 San Antonia St 510-429-9914 Fax Manifest : 42791 <br /> Hayward Ca 94544 Customer# 2232 <br /> EPA#CAL000331285 <br /> Transporter IDf14891 <br /> aerator: Contact: Sally Solanki Work:(209)466-2626 <br /> Stockton Hem atoll ow-OnoColow Frequency of Service weekly <br /> 2626 N Calfforrila St,Ste#3 <br /> Stockton,CA 95204 Pricing $950 a mo. <br /> o Transfer Facility: N Destination Facility: a Alternate Transfer Facd6ty o Destination Facility n Alternate Destination Faellityn Alternate Transfer Facility <br /> Barnett Medical Services,inc Barnett Medical Servlces,lne Healthwise Services Photo Waste Recycling Inc Curtis Bay Energy Daniels Sharpsmart <br /> 30620 San Antonio SI 2385 Arch Rd#200 4800 E.Lincoln Ave 2980 Kerner Blvd UC 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 559-834-6262 <br /> Permit#TS-87 Perm' TS10ST--10I6�Y 1(r^5}Permit#TS•89 Permit#PWR 122764 Permit#2005-WMI-0036 Permit#TS/09T-55 <br /> Date Date °' l <br /> Waste Collected: UN 3291 Regulated Medical Waste n,o,s,6.2 PG ti <br /> Sharps Containers Regulated Medical Waste Pharmaceytical Ti ace 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 /> 6gal 40gal 12 gal 20 gal <br /> 8gal 44 gal 18gal 38gal _ L 2 <br /> 12 gal Weight <br /> "oal Size Qty Weight Product Delivered: <br /> —eight: Pathogen: Item tt Description: Qt: <br /> Dental Waste: <br /> Amalgam:Size Qty Fixer.,Size Qty Developer:Size Qty <br /> Lead:Slze dt Other:Size Qt <br /> Other:Type Size Qt <br /> Notes: Hours: M-Th 8:30-1E :30 1173 <br /> Generator Certification: I hereby certify that the contents of this consignment are fully and accurately described above by proper shipping name <br /> and are classified,packed,marked,and labeled,and are in all aspects In properconditlon for transport according to <br /> applicable government regulations. <br /> I further declare that this shipment of waste is free of hazardous and mercurywaste as defined b,vlhe US"of federal <br /> regulations and/or appropriate state rules and regulation (� f <br /> Generator(Customer) <br /> '� M, /D <br /> Name ofrt.1 authorized person(print) SI e C / ate <br /> Route Driver &LQZ!:�� r ,bofi <br /> Name 4of authorized rson(print) Signature ]� Date/ <br /> -.-..erttftcate of Destruction k ` <br /> Incineration Name of author zed person(print) �ntune Date <br /> Brett Esplcha 12/16/2013 <br /> Certificate of Destruction <br /> Autoclaved Name of authorized person(print) Signature Date <br />