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Barnett Medical Services, Inc 510-429-9911 Ph Date: 0211//2015 <br /> 30620 San Antonio St 510-429-9914 Fax Manifest#: 66975 <br /> Hayward Ca 94544 Customer# 2232 <br /> Transporter ID#4891 <br /> -lerator: Contact: Sally 5olanki Worx:(M)4W2629 <br /> Stockton HematClow 0I11000100—Y- StOcki weekly <br /> 2020 N Galltofnla St,Ste#3 Frequency of Service <br /> Stockton.CA 952M4 Pricing $95t1 a rm. <br /> o Transfer Facility: N Destination Fadlity: a Mleroale Transfer Facility a Destination Fecirity (ornate Destination Facili Allemale Transfer Facility <br /> Barnett Medial Services,lne Barnett Medical Servlces,lnc Haallhwise Services Photo Waste Recycling rncP Curtis Bay Energy .nets Sherpsmart <br /> 30620 San Antonio St 2385ATch Rd#200 4800 E.Lincoln Ave 2980 Kamer Blvd#C 3200 Hawkins Point Rd 4144 E.Therose Ave <br /> Hayward CA94544 Stockton CA 95215 FowlerCA93625 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-1061," Permit#TS-89 Permit#PWR 122764 Permit#2005-WMI.0036 Permit#TSIOST-55 <br /> Dale _ _Dete a_/Itrtti� <br /> 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 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 /> 8 gal 44 gal 18 gal 38 gal <br /> 12gal Size Qty Weight <br /> lal Pathogen: Product Delivered: <br /> Weight 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 /> Nates: <br /> Generator Certification: I hereby certify that thecontents of this eonsgnmentare fully and accurately described above by proper shipping name <br /> and are classlfied,packed,marked,and labeled,and are in all aspetts In propercondition for transport according to <br /> applicable government regulations, <br /> I furtherdeclare that this shipment of waste Is free of hazardou sand mercurywaste as defined by the US codeof federal <br /> regulations and/or appropriate state rules an uiations. <br /> Gen emtor(CustraSignature Rate <br /> g mer} , R`'� —® <br /> try e -- <br /> Name of authorized person(print) <br /> Route Driver ` -- -------- __ <br /> Name ofautho zedperson(pr-nt) �^ ySdgn Date <br /> 2 110 <br /> sp <br /> Certificate of Destruction Brett Es ichor ' ""' _ ~'—------ APR -- <br /> ----_ -------- — ---- <br /> Incineration Name of authorized person(print) ,, Slgn lure '�'7 Date <br /> Certificateof Destruction Brett Cspicha -- --- ---d-�'X/lS-- <br /> Autodaved Name of au thorized person(print) Signature Date <br />