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i <br /> Barnett Medical Services, Inc 510-4—, ,-9911 Ph Date: 0411512015 <br /> 3670 Enterprise Ave Manifest#: 70684 <br /> ® p 510-266-4945 Fax <br /> Hayward Ca 94545. Customer# 2232 <br /> EPA#CAL000404096 <br /> Transporter 113#4891 r lerator: Contact: Sally Solanki bVbrk: 40,3.2626 <br /> Stockton Hell)atol00V Qnocolociv -StV-y`uencyof Service vFeEkI`y' <br /> 2620 N Calliornia St,Ste#3 <br /> Stochan.CA 95204 Pricing -5950 a of. <br /> ❑Transfer Facility: W Destination Facility: tornate Transfer Facility f�Altomate Destination Facility O Destine0on Facility <br /> Danlers SharpsmarUBMS Bamelt Medical Ssrvices,inc Da (els Shatpsmart Curtis Bay Energy Photo Waste Recycling Inc <br /> 3670 Enterprise Ave 2385 Arch Rd#200 4144 E.Therese Ave 3200 Hawkins Point Rd 2980 Kerner Blvd#C <br /> Hayward CA 94545 Stockton CA 95215 Fresno CA 93725 Baltimore MD 21226 San Rafaol CA 94901 <br /> (510)429-9911 (510)429-9911 559-34-6252 (410)354.3226 (415)459-8807 <br /> Permit#TS/CST-106 Permff#TSIOST-55 Permit#2005-WMI-0036 Permit#PWR 122764 <br /> .-Date- <br /> Waste <br /> ateWaste Collected: UN 3291 Regulated Medical Waste n.o.s.6,2 PG II <br /> Sharps Containers Re ue lated Medical Wastg (Pharmaceutical Trace Chemotheraov <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 38 gal �^ 9gal 18gal <br /> 6 gal 40gal 12 gal 20gal <br /> 8 gal 44 gal 18 gal 38 gal <br /> 12 gal Weight <br /> 'al Size Qty Weight Product Delivered: <br /> v•,;ight: Pathogen: Item# Description: Qt: <br /> Dental Waste: <br /> ArnaIgam:Sfze Qty Fixer:Size Qty DeveIoper:size Qty <br /> Lead:Size Qt Other:Slze Qt <br /> Other:Type Size Qt <br /> Notes: Hours: M-Th 8:30-12:30 1 1 30 5, n 8:50 P <br /> Generator Certification: I herebycertify flat th econtents of this cwnslgnmentare fully and accurately described above by proper shipping name <br /> and are classified,packed,marked,and labeled,and are In allaspects In proper condition for transport according to <br /> applicable government regulations. <br /> 1 further declare that this shipment of waste is free of and s a mercury wast as fine the us codeof federal <br /> t � s gu tlonsand(gr��t�tat�and guts ns. <br /> Generator Custotne II{{//�!!�// <br /> Name of authorized person(print) sf Signature Date 7 <br /> Route Driver Z "7-/S I <br /> Name ofauthbized person(print) Signa Date <br /> -ertificateofDestruction Brett Es icha � � JUN 25 2015 <br /> Incineration Name ofauthorizedperson(print) _ Sig urc a(0te <br /> /I��14/�IA,- - ,� ; <br /> CertlfBrett Esplcha <br /> xate of Destruction _ <br /> Autoclaved Name of authorized person(print) Signature Date <br />