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Barnett Medical Services, Inc 510-429-9911 Ph Date: 02!113/2®'15 <br /> Manifest#: 66976 <br /> 30620 San Antonio St 510-429-9914 Fax Customer# 2232 <br /> Hayward Ca 94544 <br /> TransporterIDN4891 <br /> stator: <br /> Contact: Sally Solanki Work:(M)465-2525 <br /> Stockton Hematoloov Onocolociv -StF equency of Service weekly <br /> 2528 P!Calffomfa Sr,arts#3 <br /> 8tochtor.CA 95204 Pricing $95>?a mo. <br /> ahrvtemale DesUnatlon Fall t(Alternate Transfer Facility <br /> n Transfer Facility: <br /> III Destination Facility; d Alternate Transfer Facility o Destination Facility r �� Daniels SharpsMd <br /> Barnett Medical Servicea,ino Barnett Medical Servlces,lnc HealUrwise Services Photo Wada Blvd <br /> #in®Inc urtls Bay Energy <br /> 2980 Kamer Blvd#C 3240 Hawkins Point Rd 4144 E.Therese Ave <br /> 30620 San Antonio St 2385 Arch Rd#200 4600 E.Lincoln Ave San Rafael CA 94901 Baltimore MD 21226 Fresno CA 93725 <br /> Hayward CA 94544 Stockton CA 95215 Fowler CA 93625 <br /> (510)429-9911 (510)429-9911 559.534-3333 (415)459-8807 emtit 5 PWR 122784 (Permit 354-3228 559-834-6252 <br /> Perm#TSIOST-55 <br /> Permit#TS-8I Parmit#TSIOST 106 Permit 0 TS-89 <br /> Date __—Date <br /> ;44— <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG 11 <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 /> 8 gal 44 gal 18 gal 38 gal �® <br /> 12 gal Size Qty Weight <br /> al Pathogen: Product Delivered- <br /> Weight: Item fit 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 /> Notes: ours: -Th 8:30-12:313 1 5, ri 8:304 <br /> Generator Certification: 1 hereby certify that the contents of this con sgnmentare fu IV and accurately described above by proper shipping name <br /> and are classified,packed,marked,and labeled,and are in all aspects In proper condition for transport according to <br /> applicable government regulations. <br /> I furtherdeclare thatthis shipmentof waste Is free of hazardous and mercury waste as defined by dna US oDdelf federal <br /> regulations and/or appropriate state rules a uladons <br /> t /5 <br /> Generator(Customer) _fi�r ��"L �Z -- Date — <br /> Name of authorized person(print} Signature <br /> Route Driver --- <br /> Nameofauth izedperson(printa til Date <br /> 'APR 13 2015 <br /> 'tiertlficateofDestruction Br tt� t cha ® _ <br /> incineration Name ofauthorized person(pdnO n 51 na ure Dae 1 <br /> (ci���� -� <br /> Brett Espicha 415 <br /> Certificate of Destrucdon — <br /> Autodaved Name of authorized person(print) Signature Date <br />