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Barnett Medical Services, Inc 510-429-9911 Ph Manliest#: -Date: f}41t18(2f115 <br /> 12015 <br /> 70683 <br /> 3670 Enterprise Ave 510-266-0945 Fax 2232 <br /> Hayward Ca 94545 Custlamer# <br /> EPA#cAL000404096 <br /> Transporter 094891 Contact: Sally Solanki work:t:D3)45-6-21525 <br /> � lerat0r: <br /> Stockton HematolOQV O"OCOIOQV -StOcki weeVi; <br /> 2620 iV California St,Ste#3 <br /> Frequency of Service <br /> Stookton,CA 95204 pricing $950 a rrpa. <br /> O Transfer Facildr. Q0 Deslinatton Facility: 14IEAItamale Transfer Facility YgAllernato Deslinatbn Facility O DosUnation Facility <br /> r/Bk1 <br /> Daniels SharpsmarS Barnett Medical Services,lne Yy inlols Sharpsmart Curtis Day Energy Photo Waste Recycling Inc <br /> 3670 Enterprise Ave 2385 Arch Rd#200 4144 E.Therese Ave 3200 Hawkins Point Rd 2980 Kamer Blvd#C <br /> Hayward CA 94545 Stockton CA 952159�34$25z 25 (410)354.3228 re MID 1226 (416)459.8807San Rafael CA��1 <br /> (510)429-9911 (510)429.9911 Permit#8252TSIOaS Permit#2005-WMI-0036 Perm!#PWR 122764 <br /> Pe It#TS/DST-106 <br /> -Date- <br /> Waste <br /> ale ate <br /> Waste Collected: I IN 3291 Regulated Medical Waste n.o.s.6.2 PIS 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 gal <br /> 4 gal 38 gal Z Z-O 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 �_ Weight <br /> -al Size Qty Weight Product Delivered: <br /> Weight: Pathogen: Item Description: Qt: <br /> Dental Waste: <br /> Amalgam:Size Qty Fixer:Size Qty Developer:Size Qty <br /> Lead:Size Qt Other:Size Qt <br /> Other:Type Slze Qt 7-6.301-4 <br /> V I- a <br /> Notes: <br /> Generator Certification: I hereby certify that thecontents of this consignment are fully and accurately described above by proper shipping name <br /> and are classified,packed,marked,and labeled,and are In all aspects In proper condition for transport according to <br /> applicable government regulations. <br /> I further declare that this shipment of waste is free of and us and mercury waste as deflne the U codeof federal <br /> re <br /> tionsan or appropriate state rules and regul ons. <br /> Generator(Customer) <br /> Name of autharized person(print)Z Signature Date <br /> Route Driver <br /> Name ofau orizedperson(print) Signat Date <br /> JUN 2.5 2015 <br /> certificate of Destruction Brett Es icha <br /> Incineration Name of authorized person(print) _ Signa re Da e <br /> Certificate of Destfuction <br /> Brett Espicha ` <br /> Autoclaved <br /> Name of authorized person(print) Signature Date <br />