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0 . 0 <br /> Barnett Medical Services, Inc 510-429-9911 Ph Date: 12131/2013 <br /> k nook30620 San Antonio St Manifest 447 <br /> 40 <br /> 510-429-9914 Fax 2232 <br /> Hayward Ca 94544 Customer# <br /> EPA#CAbD00331285 <br /> terator: <br /> Transporter ID#4891 Contact: Salty Solanki Work:(209)466-2625 <br /> Stockton Hematology-OnocologV weekly <br /> 2626 N California St,Ste#3 Frequency of Service <br /> Stockton,CA 95204 $950 a ma. <br /> Pricing <br /> a Transfer Facility: Of Destination Facility: o Allernate Transfer Facility o Destination Facility a Alternate Destination Fadlityo Alternate Transfer Facility <br /> Barnett Medical Servlces,lnc Barnett Medical Services,inc Healthwise Services Photo Waste Recycling Inc Curtis Bay Energy Daniels Sharpsmart <br /> 30620 San Antonio SI 2385 Arch Rd 8200 4800 E.Lincoln Ave 2980 Kerner Blvd#C 3200 Hawkins Point Rd 4144 E.Therese Ave <br /> Hayward CA 94544 Stockton CA 95215 Fowler CA 93625 Sen Rafael CA 94901 Bakimore MD 21226 Fresno CA 93725 <br /> (510)429-9911 (510)429.9911 559-834-3333 (415)459-8807 (410)354-3228 559.834-6252 <br /> Permit#TS-87 PerOV/OST 10{6] ( ( Permit#TS-89 Permit#PWR 122764 Permit#2005-WMI-0036 Permit U TSIOST-55 <br /> Date <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG II <br /> Sharps Containers 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 gat 38 gal + 9 gal 18 gal <br /> 6 gal 40 gal 12 gal 20 gal <br /> 8 gal 44 gal 18 gal 38 gal <br /> 12 gal Weight <br /> ,at Size Qty Weight Product Delivered: <br /> Weight: Pathogen; Item# Description: Qt: <br /> Dental Waste: <br /> Amalgam:Size Qty Fixer:Size Qty Developer:Size Qty <br /> Lead:Size Qt Other:Size Qt <br /> Other:Type Size Qt <br /> Notes: - <br /> SEP 3:M4 <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 proper condition for transport according to <br /> applicable government regulations. <br /> I further declare that this shipment of wast is free of hazardous and mercurywaste as defined by the US code of federal <br /> regulations alnd,/or appropriate state rules d regultions f I <br /> Generator(Customer) V�4, `' �` ��r� <br /> Name of authorizeed,person(print) Signature Dape <br /> Route Driver , l/Y �2L f It 3 <br /> Name of aut prized person(prints Signature Date <br /> -Certificate of Destruction <br /> Incineration Name of authorized person(print} y(sgn tui Date <br /> Brett Espicha �]�/l�i '`' 1/3/2014 <br /> Certificate of Destruction <br /> Autoclaved Name of authorized person(print) Signature Date <br />