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Barnett Medical Services, Inc 510-429-9911 Ph Date: 01121/2015 <br /> ®a 30620 San Antonio St 510-429-9914 Fax Manifest#: 6672 <br /> Customer# <br /> Hayward Ca 94544 232 <br /> Transporter ID#4891 <br /> Aerator: Contact: Sally SDlanki Work:(209)466.1026 <br /> Stockton Hetnatotogv-OnoColociv weekly <br /> 2020 N c+aliiornia sr,STe#3 Frequency of Service <br /> Stockton,CA. 95204 Pricing $950 a rm. <br /> o Transfer Fedlily: ail Destination Facility: o Allemate Transfer Facility o Destination Facility mala Destination Facih ale Transfer Faatlty <br /> Barnett Medical Services,tnc Barnett Medical Services,inc Heaithwlse Services Photo Waste Recycling I Curlts Bay Energy motsniels Sharpsmad <br /> 30620 son Antonio St 2385 Arch Rd#200 4800 E.Lincoln Ave 29W[Cerner Blvd#C 3200 Hawkins Point Rd 4144 E.Thorese Ave <br /> Hayward CA 94544 Stockton CA 95215 Fowler CA 93625 Son Rafael CA 94901 Baltimore MD 21226 Fresno CA 93725 <br /> (510)429-9911 (510)429.9911 55g-B34-3333 (415)459.8807 (410)354.3228 559-934.8252 <br /> Permit#TS-87 Permit#TS10ST-106 Permit#TS-89 Permit#PWR 122764 Permit#2005-WMI.0036 Permit#TSIOST-55 <br /> DateDatej,:; <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 gal 38 gal �_ 9 gal 18 gal <br /> 6 gal 40 gal 12 gal 20 gal <br /> 8gal 44 gal 18 gal 38 gal <br /> 12 gal Size Qty Weight <br /> jai Pathogen: Product Delivered: <br /> weight- Item# Description: Qt: <br /> Dental Waste: <br /> Amalgam:Size QtyFixer:Size Qty Developer:Size Qty— <br /> Lea d: <br /> tylead:Size Qt Other:Size Qt <br /> Other:Type Size Qt <br /> Notes: ours: t4-1 F, :� ri 8:30-4 <br /> Generator Certification: I hereby certify that thecontents of this consgnmentare fuly and accurately described above by proper shipping name <br /> and are classified,packed,marred,and labeled,and are In all aspects In proper condition for tran sport according to <br /> applicable government regulations. <br /> I further declare that this shipment of waste is free of haz andimercurywasto as defineo3w the US code of federal <br /> re lations anppr priatestate rules and regula s. <br /> Generator(Customer) A.7/r <br /> Name of authorized person(pr t) Signature Date <br /> Route Driver L' - A&k?-----_--- --------, s-- <br /> Name of au ori zed person(prht) 9 f-q5 0i <br /> Date <br /> Certificateof Destruction - MAR 0 2 2015 <br /> -- tEp <br /> ------—�—--- — <br /> Incineration Nameofauthorizedperson(print) An ture D to <br /> Certifkate of Destruction Brett Espicha ---T__— — -------_ lel J— <br /> Autodaved Name of authorized person(print) Signature Dale <br />