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Barnett Medical Services, Inc 510-429-991'1 Ph Date: 03/25/2015 <br /> 1W30620 San Antonio St 510-429-9914 Fax Manifest M 70681 <br /> Hayward Ca 94544 Customer# 2232 <br /> Transporter 094891 <br /> lerator: Contact: Sally Solank; Work:(209)A56-2826 <br /> Stockton HematoloQv 0n0c010QV -Stn cluency of Service weekly <br /> 2628 N Califomia St,Ste#3 <br /> Stockton,CA 95204 Pricing $950 a rr*• <br /> o Transfer Fadlity, 0 Destination Facility: ��ry.�'tomale Transfer Fauiity Ooatinatlon Facility �ANemate Destination Fad Alternate Transfer Facility <br /> Barnett Medical Servicas,lnc Damen Medical Servioes,lnc -"Healtttx4se Serotcas Photo Waste Recycling Inc Curtis Bay Energy 144 E.Therese Avead <br /> 30820 San Antonio St 2385 Arch Rd#200 4800 E.Lincoln Ave 2980 Kerner Blvd#C 3200 Hawkins Point Rd 4144 E.Therese Av <br /> Hayward CA 94544 Stockton CA 85215 FowlerCA93525 San Rafael CA 84901 8altirnoro MD 21228 Fresno CA 93725 <br /> (510)429-9911 (510)429-9911 559-834-3333 (415)459-8807 (410)354-3228 559-834.6252 <br /> Permit#T"7 Permit#TSIOST-108 Permit#TS-89 Permit#PWR 122764 Peril#2005-WMI-0038 Permit#TSIOST 55 <br /> Date— al <br /> J91— at D 3 /Xs <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s,6.2 PG 11 <br /> Shams Containers_Regulated Medical Waste Pharmaceutical Trace Chernothera <br /> Size Qty: Size Qty: Wt Size Qty: Wt: Size Qty: Wt <br /> Up to: 3 gal <br /> 2gal 20 gal 8gal 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# Description: Qt: <br /> Dental Waste: <br /> Amalgam:Stze Qty Fixer.Size QtyDeveloper:Size Qty <br /> Lead:Size Qt Other:Size Qt <br /> Other:Type Size Qt <br /> Notes: Hours: M-Th 8:30-92:30 11:30-5, 1'ri 8:30-4 <br /> Generator Certification: ciled, nr fully accurately <br /> described rtby sshipping <br /> name <br /> assifdpacked,marked,and labeledand are Iataspects nproerrconditionforanportaccording to <br /> applicable government regulations. <br /> Ifurtherdeclarethatthlsshipmentofwaste Isfree ofhe o sandm rcu wasteas efl d NueUSwdeoffederal <br /> r lations an a ropr'ate state Riles an a uta S. <br /> Generator tCustomer) <br /> ame of authorized per n(prFut) Signature Date <br /> k?Route Driver _l!I?�-- —' s—� <br /> Date <br /> Name ofaut lzedperson(prnt) (Y/f v99 twe MAY 2 8 2015 <br /> Certificate of Destruction Brett Espicha_ <br /> Incineration Nameof authorized person(print) r„� Sig lure y Daf e <br /> Certificate of Destruction <br /> Brett Espicha 3 ),� JS- <br /> Autodaved Name of authodzed person(print) Signature Date <br />