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Barnett Medical Services, Inc 510-429-9911 Ph Date: 02i25,2015 <br /> Manifest 66977 <br /> ®� 30620 San Antonio St 510-429-9914 Fax Customer# 2232 <br /> Hayward Ca 94544 <br /> Transporter(D#4891 <br /> t stator: Contact: <br /> Sait~d -Diank.i > iyrF.,IM)456-Mo <br /> Stockton HelttatolocfY onocoi4Uv-Stocki Y eekIy <br /> Frequency of Service <br /> 20126 N California st,Ste#3 X950 a tyro. <br /> Stockton.CA 95204 Pricing <br /> CP Destlnadlon Facility NCAllemate Destination FecI1M&LAftemate Transfer FadW <br /> o Transfer Fad W.. Q! Destination Facility: a Ntemale Transfer Facility Curtis 7F l�3anlels Sharpsmarl <br /> t3amefi Medical Servtces,tne Bamelt Medical Servires,InC 4 eaRhE'sLs Zoo WasKemte p vd ung inc 3200 Hawkins Point Rd 4144 E.Therese Ave <br /> 30620 San Antonio St 2385 Arch Rd#200 <br /> Hayward CA 94544 Stockton CA 95215 Fowler CA 93625 San Rafael CA 9 4901 Fialtimore MO 21226 Fresno CA 93725 <br /> (510)429-9911 (510)429-9911 559-B34-3333 <br /> (4i5)459-=7 WR (410)354.3228 6594134-6252NTS1 <br /> Permit#TS-87 Pemest#TSJOST 1008! Permit#TS-89 permit#P1NR 122764 Permit#2W5 WMF0036 Permit#TSIOST 55 <br /> Date Dale1S'T <br /> Waste collected: UN 3291 Regulated Medical Waste n.o.s.6.2PG II <br /> Sharps Containers Regulated Medical Waste Pharmaceutical Trace Chemotlteraay <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 /> --alPathogen Product Delivered: <br /> Item# Description: Qt: <br /> kvGight:1/5 <br /> Dental Waste: <br /> AmaIgam:51ze . Qty FIXer:Slze Qty DeveIoper:Size Qty <br /> Lead:Size Qt Other.Size Qt <br /> Other:Type Size Qt <br /> ours: f': ri 8:.0 <br /> Notes: <br /> Generator certification: I hereby certify that the contents of this con sgnmant are fu ly an d accurately descdbed above by Proper shipping name <br /> and are c lassif led,p ac ked,marked,and tobeled,and are In all aspecis In proper condition for tratsport according to <br /> applicable gavernment regulations. <br /> Ifurtherdeclarethat this shipmentofwasteisfree ofha us d m ercury wa ste fi bytheUScad a0ffederaI <br /> regu tions and/orapprom ate state 1,les a u1aB s. <br /> Generator(Customer) � — Date <br /> s nature <br /> airy of authorized person(pr' i) g <br /> Route prhrer <br /> Name of out rued person(pritt) 9gnars Date <br /> APR 2 3 2015 - <br /> ,:artificate of Destruction <br /> 9 n lure <br /> Incineration Name afauthoizedperson(print} Datk <br /> �� � C� � j Brett Esplcha / ` — <br /> Certificate of Destruction �-- —.� — — <br /> Autoclaved Name ofautitorizedperson(print) <br /> Signature Date <br />