Laserfiche WebLink
Afflt Barnett Medical Services, Inc 510-429-9911 Ph ®ate: 01/14/2015 <br /> 1W6971 <br /> 30620 San Antonio St 510-429-9914 Fax Manifest r 2232 <br /> Hayward Ca 94544 Customer <br /> X232 <br /> Transporter ID#4891 <br /> ner&tor: Contact: Sally Solanki vvorR:Com)45&26X <br /> Stockton Hernatoloc V-0nocolOCIV Frequency of Service weekly <br /> 202614 California 8r,Ste#3 <br /> Stockton,CA 95204 Pricing $9510 a rro' <br /> n Transfer Facility: t9 Destination Facility. o Alternate Transfer Facility o Destination Facility ,/04AUemato Destination Facila t�era o Transfer Facility <br /> Barrell Medical Services,inc Barnett Medical Services,lnc Healthwise Services Photo Waste Rocyciing in Cunis Bay Energy Ps n <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 /> (610)429-9911 (510)429-9911 559.834.3333 (415)459.8807 (410)354.3228 559-834-6252 <br /> Permit#TS-87 Permit#TSIOST 1013 Permit#TS-89 Permit#PWR 122764 Permit#2005-WMI-0036 Permit#TSIOST 55 <br /> Dale LN— -Date — <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG II <br /> Shams 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 gal 38 gal �(� 9 gal 18 gal <br /> 6 gal 40 gal 12 gal 20gal <br /> 8 gal 44 gal 18 gal 38 gal �� /D <br /> 12 gal Size Qty Weight <br /> Sal Pathogen: Product Delivered: <br /> Weight: Item# Description: Qt: <br /> Dental Waste: <br /> Amalgam:Size QtyFixer:Size Qty Developer:Size Qty <br /> Lead:Size Qt Other:Size Qt <br /> Qther:Type Size Qt <br /> Notes: ours: - ri 8:304 <br /> Generator Certification: I herebycertify that thecontents of this consgnmentare fully and acwratelydescdbed above by proper shipping name <br /> and are cfassifled,packed,marked,and labeled,and aro In allaspects in properconditloo for transport according to <br /> applicable government regulations. <br /> I furtherdeclare that this shipment of waste is free of ha do sand mercury waste as defined by the US cod eof federal <br /> gu lions and/or� testate rotes and reguia s. <br /> Generator(Customer) <br /> Name of authorized parson(print) Signa ore Date <br /> Route Driver - __—— --------- ~® !r� <br /> Name of auth tied person(print) 9gna— Date <br /> MAR,0 2 2015 <br /> Certificate of Destruction -- Brett Esq.icha — ,— -- -- ----- <br /> Incineration Name of authorized person(pdnt) ,, Sgn ture l as <br /> Brett Espicha !k� -- — �qj �— <br /> Certificate of Destruction-r--- ---� -- <br /> Autoclaved Name of authorized person(print) signature Date <br />