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Barnett Medical Services, Inc 510-42Date: 'i]41p1/2p1S9-9911 Ph Manifest#: 70682 <br /> W <br /> 3670 Enterprise Ave 510-266-0945 Fax Customer# 2232 <br /> Hayward Ca 94545 <br /> EPA#CAL000404096 <br /> Transporter iD#4891 Sally Solanki Work:(2D9}465.2525 <br /> r leratOr: Contact: <br /> Stockton Hematoloav Onocolow--Stock' weekly <br /> Frequency of Service <br /> 2620 11 California at,�tE#3 <br /> Stockton.CA 95204 Pricing $050 a <br /> lemate Transfer Facility XAlemate Destination Facility Destination Facility <br /> ®Transfer Facility: 0 Destination Facility: H <br /> Daniels980 Kerner Blyd#C <br /> SharpsmaNBMS Barnett Medical Services,InC �4144 <br /> niels Sharpsmart Curtis Bay Enargy oto Waste Recycling Inc <br /> 3570 Entorprise Ave 2385 Arch Rd 11200 E.Therese Ave 3200 Hawkins Point Rd San Rafael CA 94901 <br /> Hayward CA 94545 Stockton CA 95215 Fresno CA 93725 Baltimore MD 21228 <br /> 559-834-8252 (410)354-3228 (415)459-6807 <br /> (510)429-9911 (510)429-9911 <br /> Permn <br /> it#TWOST-1013 Permit#TS/OST-55 Pe+mit#2005-WMI-0036 Permit#PWR 1227 <br /> Date ,�Dale <br /> 11 <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG 11 <br /> Sharps Containers Regul ited Medical Waste Pharmaceutical Trace Chemothgra <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 /> 4gal 38gal f� 9gal 18 gal <br /> 6 gal 40 gal 12 gal 20 gal <br /> 8 gal 44 gal 18 gal 38 gal <br /> 12 gal Weight <br /> '- -al Size Qty Weight Product Deliypred: <br /> 4.elght: <br /> Pathogen: Item#i Description: Qt: <br /> Dental Waste: <br /> Amalgam:Size QtyFixer:Size Qty Developer:Size Qty <br /> Lead:Size Qt Other:Slze Qt <br /> Other:Type Size Qt <br /> au s: - ri E:30�1 <br /> Notes: <br /> Generator Certification: I herebycertify that thecontents of this conalgnmentare fully and accurately described above by proper shipping name <br /> and are classified,packed,marked,and labeled,and are in spects in proper condition for transport according to <br /> applicable government regulations. <br /> I further declare that this shipment of waste Is free or azardo s and rcurywaste a Ine by the US codeof federal <br /> rn <br /> a r prig a state rule s and re ul tions. <br /> 3�( <br /> q-1-1 Lg377 <br /> Generator(Customer) <br /> -Name of authorized person(print) Signature Date <br /> All( <br /> Route Driver <br /> ow--6 96�3.— <br /> Name of authdrized person(print) signa Date <br /> JUN ;6 2015 <br /> ,.ertificate of Destruction Brett£s Icha <br /> Incineration Name of authorized person(print) A) Signa ur' D te. <br /> Certificate of Destruction <br /> Brett Esplcha (I(�19/1a <br /> � ��� <br /> Date <br /> Au cod aved <br /> Name of authorized person(print) Signature <br />