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Barnett Medical Services, Inc 510-429-9911 Ph Date: 12/24/2013 <br /> 30620 San Antonio St 510-429-9914 Fax Manifest 44739 <br /> Hayward Ca 94544 Customer# 2232 <br /> EPA#CAL000331285 <br /> Transporter ID#4891 <br /> ierator: Contact: Sally Solank( Work:{209)465-2526 <br /> Stockton Hem atoll ogv-Onocofo weekly <br /> 2826 N California St,Ste#3 Frequency of Service <br /> Stockton,CA 95204 Pricing $950 a rno. <br /> C Transfer Facitily: CO Destination Factiity: a Alternate Transfer Facility a Destination Facility ❑ Alternate Destination Facilityn Alternate Transfer Facility <br /> Barnett Medical Sprvlces,16o Barnett Medical Services,lnc Heallhwise Services Photo Waste Recycling Inc Curtis Bay Energy Daniels Sharpsmart <br /> 30620 San Antonio St 2385 Arch Rd 4200 4800 E.Lincoln Ave 2980 Kerner Blvd A1C 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 559834-3333 (415)459-8807 (410)354-3228 559-834-8252 <br /> Permit#T8-87 Per- �s�-_ST-1 Permit#TS-89 Permit#PWR 122764 Permit#2005-WMI-0036 Permit#TSIOST-55 <br /> Dale Date <br /> Waste Collected: UN 3291 Regulated Medical Waste n•o.s.6.2 PG 11 <br /> Sharps Containers Regulated Mgdlcal Waste Pharmaceutical Trace Chemotherap <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 40 gal 12 gal 20ga1 <br /> 8 gal f 44 gal 18 gal 38gal <br /> 12 gal Weight <br /> 'al Size Qty Weight Product Delivered: <br /> Weight: /Q Patitop}en: Item# Description: Qt: <br /> Dgntal Waste: <br /> Amalgam:Size Qty Fixer:Size Qty Developer:Slze Qty <br /> Lead:Size Qt Other:Size Qt <br /> Other:Type Size t <br /> Notes: - <br /> Generator Certifleat[on: I herebycertify that the contents of this consignment are fully and accurately described alcove by proper shipping name <br /> and are classified,packed,marked,and labeled,and are in all aspects In pro percondition 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 by LIS code of federal <br /> regulations and/or appropriate state rides and regulations. <br /> Generator(Customer) <br /> Name of authorized person(print) nature ate <br /> Route Driver ,}�( j3 <br /> Name of authorize person(print) Aignature Date v <br /> Certlflcate of Destruction 17t.c l'f'" C 3��1�i <br /> Incineration Name ofauthori dperson(print) furs, Date <br /> Brett Espicha 12/29/2013 <br /> Certificate of Destruction <br /> Autoclaved Name of authorized person(print) Signature Date <br />