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t3amett Medical Services, Inc 510-429-9911 Ph Date: 0311812015 <br /> .i 30620 San Antonio St 510-429-9914 Fax Manifest : 2232 <br /> Hayward Ca 94544 Customer# 2232 <br /> Transporter ID#4891 <br /> erator: Contact: Sa$/Solani:i wow 09)45E-26'26 <br /> Stockton Herttatolo(iv lanocologY - StocFreuenoy of Service vreekly <br /> 2620 N Califomia St.Ste#3 <br /> Stockton,CA 85204 Pricing $950 a MD. <br /> o Transfer Facility: til Destination Feebly: o Alternate Transfer Facility a Destination Facility `rd-�Allemate Destination Facild Alternate Transfer Fatty <br /> Barnett Medical Services,ine Barnett Medical Servicas,ine Healthvrtse Services Photo Waste Recycling Inc Curtis Bay Energy \Daniels Sharpamart <br /> 30520 San Antonio St 2385 Arch Rd#200 4000 E.Lincoln Ave 2980 Kamer Bind#C 3200 Hawkins Point Rd A144 E.Theresa Ave <br /> Hayward CA 94544 Stockton CA 95215 Fowler CA 93625 San Rafael CA 94901 Baltimore MD 21220 Fresno CA 93725 <br /> (510)429-9911 (510)429-9911 559.834-3333 (415)4594W7 (410)354-3228 55934.6252 <br /> Permit 9 TS-81 Permit#TS/OST--106 Permit 9 TS419 Permit#PWR 122794 Permit#2005-WM1-0035 Permit di TSIOST 55 <br /> Data �Dete <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PIS 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 /> 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 /> 31 Pathogen: Product Delivered: <br /> Weight: Item# Description: Qt: <br /> Mental 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. Hours: M-Th 8:30-12:30 11:30-5, ri 8:30-4 <br /> Generator Certification: I herebycertify that the contents of this consignment are Mly and accuratelydescdbed above by proper shipping name <br /> and ate cbssifled,packed,marked,and labeicd,and are in all aspects In proper condition for transport according to <br /> applicable government regulations. <br /> Ifurtherdedlarethat this shipment ofwaste Isfree hazar us mercurywa easdefiroedbytheUScodeoffederal <br /> regph onsand/ r appropriate state rule nd re ations. <br /> Generator(Customer) / ( _ -�—. �.� — 2 234,57 <br /> Name of authorized person(print) V Sign urn Date <br /> Route Driver 4, 2-- <br /> zed person(prht) Sign urn Date <br /> MAY 2 8 2015 <br /> Certificate of Destruction_ Brett_ Esoieha — — ----- <br /> Incineration Name ofauthorized person(pdnt) �tg lure 4e <br /> Certificate of Destruction 8rettEspicha _ -- 3TL�j1:� <br /> Autoclaved Name of authorized person(print) Signature Date <br />