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Barnett Medical Services, Inc 510-429-9911 Ph Date: 03/®4/2015 <br /> ®a Barne San Antonio vi Manifest : ssQ�� <br /> 510-429-9914 Fax Customer# 2232 <br /> Hayward Ca 94544 <br /> Transporter ID#4891 <br /> ( berator: Contact: <br /> Sally Solanki Work:(109)466.2526 <br /> stock–ton HR[tiatolow GR00011ficiv - stock-( weekly <br /> 2620 N California 511,Ste#3 Frequency of Service <br /> Stockton,CA 95204 Pricing $950 a rrv:�_ <br /> a Transfer FedNty CR Destination Facility: o Alternate Transfer Facittly n Destination Facility Alternate Destination Fa AKomateTransfer Facility <br /> Damon Medical SerAces,lnc Barnett Medical Services,inc Healdrwfse Services Photo Waste Recycling Inc Curtis Bay Energy anuels Sharpsmad <br /> 30620 San Antonlo 51 2365 Arch Rd#200 4800 E.Lincoln Avo 2980 Kamer Blvd#C 3200 Hawkins Point Rd 4144 E-Therese Ave <br /> Hayward CA 94544 Stockton CA 95215 Fowler CA 93625 San Rafael CA 949011 Baltimore MD 21226 Fresno CA 93725 <br /> 415 459.8807 (410)354-3226 559-834.6252 <br /> (510)429-9911 (510)429-9911 55934-3333 ( ) <br /> Pemilt#TS-87 Pertnft#TS10ST-106 Permil#T"9 Permit#PWR 122764 Pemrtt#2005 WM10036 Permit#TS/05T-55 <br /> te6—WDate mak- at-A&6— <br /> Waste <br /> aste 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 /> 2gal 20gal 8gal 12 gal <br /> 4gal 38gal 9gal 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: ICS Item## Description: Qt: <br /> Dental Waste: <br /> AmaIgam:Size Qty Fixer:Size Qty Developer:Size Qty <br /> Lead:Size Qt Other.Size Qt <br /> Other:Type Size Qt <br /> Notes: ours: Z 2: ri 8:3D-4 <br /> Generator Certification: I herebycertify that th econtents of this oonsgnment are fu ly and accurately deudbed above by proper shipping name <br /> and are classified,packed,marked,and labeled,and are In allaspects In propercondition for transport according to <br /> applicable Ilovernment regulations. <br /> I further dedare that this shipment of waste Is free of hazardous and mercury was as defhred by the uS ood eof federal <br /> regulations and/or appropriatestaterules and regutatl s , f <br /> Generator(Customer) <br /> Name of authorized person(prh signature `� Date <br /> Route Driver _&47 <br /> Name of a orized person(print) Sign Date <br /> - --� MAY 2 8 2015 <br /> tierdtkate of Destruction_— Brett Espicha-- _ — __ --.----- — <br /> Incineration Name ofauthorized person(print) urs D e <br /> //� <br /> t;,eref(cateofDestruction Brett Espicha--- — — —.r----------- <br /> --- <br /> Autodaved Name of authodzedperson(print) Signature Date <br />