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Barnett Medical Services, Inc 510-429-9911 Ph Manifest : 66979 <br /> ®a Date: O'J1'i f20�i 5 <br /> 30620 San Antonio St 510-429-9914 Fax Customer# 2232 <br /> Hayward Ca 94544 <br /> Transporter 10#4891 �,� <br /> f Derator: <br /> Contact: Sally Solanki 7` uvolh,12W)466-2626 <br /> Stockton HeitlatoloOV Onocologv - Stock' <br /> 2826 iV CaliforniaSt,Ste#3 <br /> Frequency of Service <br /> Stockton.CA 9.5244 pricing $950 a rrin. <br /> o Transfer 17401Hy: M Destination Fedllty' o Alternate Transfer Facility o Destination Facility ] temate Destination Facili Alt$Is TaransrpsnfearFacility <br /> Barnett Medical Service-One Barnett Medical Services,inc Healthwise Servlcces Photo Waste Recycling InQ Ctrals Bay Energy <br /> 30620 San Antonio St 2385 Arch Rd#200 4809 E.Lincoln Ave 2980 Kerner Blvd#C 3200 Hawkwts Point Rd 4144 E.Therese Ave <br /> Hayward CA 94544 Stockton CA 95215 Fowler CA 93625 San Rafael CA 94901 Baltimore MD 21226 Fresno CA 93726 <br /> {510)429-9911 {610)429 9911 559.834-3333 (415)459-8607 (410)354.3228 559-834.6252 <br /> Permlt#TS-67 Permit#TS/OST-106 Permit#TS-89 Permit#PWR 122784 Permit#2005-WM1-0036 Permit#TSiOST 55 <br /> DateP_Dat e `j" <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 gat <br /> 4 gal 38 gal . L 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 f Size Qty Weight <br /> al Pathogen: Product Delivered: <br /> Weight: /0 Item# Description: Qt: <br /> Dental Waste: <br /> Amalgam:Size Qty Fixer:Size QtyDeveloper:Size Qty <br /> Lead:Size Qt Other:Size Qt <br /> other:Type Size Qt <br /> our : ri 8:80-4 <br /> Notes: <br /> Generator Cerdficatlon: 1 herebycertlfy that thecontents of thisconslgnmentare fully and accuratelydescrtbed above by proper shipping name <br /> and ate clessifed,packed,marked,and labeled,and are In allaspects in properconditionfor transport according to <br /> applicable government regulations. <br /> 1 furtherdeclare that this shlpmentofwaste is free-of hazardousand mercurywaste as defined by The US codeof federal <br /> regulations and/or appropriate state riles and re ulabons. <br /> Generator(Customer) — SA�2R�Lf _— _ ----_— ®--® `�—3 <br /> Name of authorized person(print) Signature 2Date — <br /> Route Driver C,44,4 Q `2-- v. uth izedperson(prnt) Sig tore Date <br /> Certificate of Destntctlon Brett Ess icha � _ MAY 2 8 2M — <br /> Incineration Name ofauthorized person(print) g�ur3tCoL <br /> Brett Espicha <br /> CerdflcateofDestnfction <br /> ---- _���,__-- ---- -- — --- <br /> Autodaved Name of authorized person(print) Signature Date <br />