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Barnett Medical Services, Inc 510-429-9911 Ph Date: 02/0412015 <br /> le 30620 San Antonio St 510-429-9914 Fax Manifest#: 66974 <br /> Hayward Ca 94544 Customer# 2232 <br /> Transporter ID#4891 <br /> nerator: <br /> Contact: Sally Solanki Work:M)456-2625 <br /> Stockton Hematolociv Onocolociv- Stocki weekly <br /> 2626 N California St,Ste#3 Frequency of Service <br /> Stockton,CA 95204 Pricing $950 a mo' <br /> c)Transfer Facility: D1) Destination Facilhy: a Altemate Transfer Facility o Destinalion Facifity Ilema,:Dostinallon Facia Alternate Transfer Facility <br /> Barnett Medical Services,inc Barnett Medical Servicos,inc Healthwise Services Photo Waste Recycling In Curti.8 <br /> Bay Energy '-Daniels Sharpsmart <br /> 30820 San Anlonlo St 2385 Arch Rd#200 4800 E.Uncoin Ave 2980 Kamer Blvd#C 3200 Hawkins Point Rd 4144 E.Therese Ave <br /> Hayward CA 94544 Slockton 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 559-834-6252 <br /> Permit#TS-87 Permit#TSIOST 106 Permit#T"9 Permit#PWR 122764 Permit#2005-WMI.0036 Permit#TS/OST-55 <br /> Date lin —Data�S� <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 /> Ulf to: 3 gal <br /> 2 gal 20 gal --;-�-- 8 gal 12 gal <br /> 4 gal 38 gal _� . IV 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 Size Qty Weight <br /> ;al Pathogen: Product Delivered: <br /> weight: Item 1# Description: Qt: <br /> Dental Waste: <br /> Amalgam:Size QtyFixer:Size QtyDeveloper:Slze Qty <br /> Lead:Size Qt Other:Size Qt <br /> Other:Tye Size Qt <br /> ours: ri 8:30-i <br /> Notes: <br /> Generator Certification: I herebycertify that thecontents of this consgnmentare fully and accurately described above by proper shipping name <br /> and are classified,packed,marked,and labeled,and are in allaspects in propercondition for t ran sport according to <br /> applicable government regulations. <br /> I furtherdeclare thattlils shlpmentof waste Is freeof hazardousand mercurywaste as defined by the US codeof federal <br /> regulations and/or appropriate state rules ad-feeotions. ter, <br /> Generator(Customer) <br /> Name of authorized person(1�prn t)~ Signature �Date <br /> Route Driver —_�/15.�_--_-- ~ — <br /> Name of autho zed person(print) Signa Date <br /> 613* <br /> Brett I; icha _� — APR 2 3 2015 <br /> Certificate of Destruction —` � ---- —.--- <br /> ----- <br /> Incineration Name of authorized person(print) n tun ^ale t! , <br /> or-�ss,(EEEij t � <br /> Certifitate of Destruct]an Brett Espicha--- —_._.----- -- --------------- — <br /> Atltodaved Name of authorized person(print) Signature Date <br />