Laserfiche WebLink
Barnett Medical Services, Inc 510-429-9911 Ph Date: 01/0712015 <br /> ®� 970 <br /> 30620 San Antonio St 510-429-9914 Fax Manifest r 232 <br /> 2 <br /> Hayward Ca 94544 Customer# 2232 <br /> Transporter 10#4B91 <br /> nerator: contact: Sally Solanki Werk:(W)46&2526 <br /> Stockton Herriatoiociv-0noCulerav Frequency of Service `+r=ekly <br /> 2626 N Callomla St,Ste#3 <br /> Stockton,CA 95204 Pricing $950 a ice. <br /> o Transfer Facility: M Destination Facility: o Alternate Transfer Facility a Destination Facility mato Destination Faali AlternateDenials <br /> S Transfer Facitity <br /> Barnett Medical Services,rnc Barnett Medical Servlces,inc Healthwise Services Photo Waste Recycling Inc Curtis Bay Energy aniois Sharpsman <br /> 30620 San Antonio St 2385 Arch Rd#200 4800 E.Lincoln Ave 2980 Kerner Blvd#C 3200 Hawkins Point Rd 4144 E.Therese Ave <br /> Hayward CA 94544 Stockton CA 95215 Fowler CA 93625 San Rafael CA 94901 Baltimore MD 21226 Fresno CA 93725 <br /> (510)429-9911 (510)429.9911 559-834-3333 (415)459.8807 (410)354.3228 559-634.6252 <br /> Permit#TS-87 Permit#TS/OSTA05 Permit#TS-89 Permit#PWR 122754 Permit#2005-WMI-0036 Permit#TS/OST 55 <br /> — <br /> Dale-Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG II <br /> Sharps Containers Regulated Medical Waste Pharmaceutical Trace Chemothera <br /> Size Qty: Size Qty: Wt S1ze Qty: Wt: Size Qty: Wt <br /> Up to: 3 gal <br /> 2 gal 20 gal 8 gal 12 gal <br /> 4 gal 38 gal 1® 9 gal 18 gal <br /> b gal 40 gal 12 gal 20 gal , <br /> 8 gal 44 gal 18 gal 38 gal / --- 1 <br /> 12 gal Size Qty Weight <br /> jai Pathogen: Product Delivered: <br /> v.eight. Item g Description: Qt: <br /> Dental Waste: <br /> Amalgam:Slze Qty Fixer:Size Qty-Developer:Size Qty <br /> Lead:Size Qt Other:5)ze Qt <br /> Other:Type Size Qt <br /> Notes: ours: -Th 8:30-12;30 11:3G-5$ ri 8:30-4 <br /> Generator Certification: I hereby certify that the contents of this consgnmentare fuly and accurately described above by proper shipping name <br /> and am etassifl2d,packed,marked,and labeled,and am in all aspects in proper condition for transport according to <br /> applicable government reguladons. <br /> I further dedare that this shipment of waste Is free qofa2dou and mercuryw to defined by the US codeof federal <br /> btions gd or a propriatestatenrks an uGenerator(Customer) [ �Name or authorized person(pr SignatuDate <br /> Route Driver _-- — ---� � — <br /> Name of author ed person(prht) Sgnalure Date <br /> MAR A 2 2015 <br /> -Certificate of Destruction —_---- --^ ��' -- _---,------ <br /> Incineration Name&S9ltfihfdaIfJ)s%n(print) SL2,) Dat <br /> eofDestruction — / ----- -- ��(' <br /> Certificate --IG� <br /> —`$fe!tt'�5p1t'lTa""—'--- <br /> Autodaved Name ofauthorizedperson(print) Signature Date <br />