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Barnett Medical Services, Inc 510-429-9911 Ph Date: 04/2212015 <br /> ® 3670 Enterprise Ave 510-266-0945 Fax Manifest#: 71957 <br /> 95 <br /> Hayward Ca 94545 Customer# <br /> 32 <br /> EPA#CAL000404096 <br /> � <br /> aerator: <br /> Transporter ID#4891 contact: mall Solanki vu01k:lam] 1.6 <br /> )4 .2626 <br /> Stockton HentatologV Ci,oeoiogy - Stock! weekly <br /> 2028 N California 51,Ste#3 Frequency of Service <br /> Stockton,CA 95204 Pricing $050 a rro. <br /> (3 Transfer Facility. M Desunaflon Facility: emate Transfer Facility `xAllemale Destination Facility O Destination Facility <br /> Daniels SharpsmerUBMS Barrett Medical Selvioes,inc Daniels Stwrpsmart Curtis Bay Energy Photo Waste Rerydirppinc <br /> 3470 Enterprise Ave 2385 Aroh Rd#200 4144 E.Therese Ave 3200 Hawkins Point Rd 2960 Komar Blvd#C <br /> Hayward CA 84545 Stockton CA 95215 Fresno CA 93725 Baltimore MD 21226 San Rafael CA 94901 <br /> (510)4299811 (510)429-9911 659-834-6252 (410)354-3226 (415)459-8807 <br /> Pemtit#TSIOST--106 Permit#TWOST-55 ParmX#2005-WM I-0036 Permit#PWR 122764 <br /> Date DatewS <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG II <br /> Sharps Contalner5 Regulated Medical Waste Pharmaceutical Trace Chemotherapt <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 0 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 /> -ai Size Qty Weight Product Delivered: <br /> Weight: t o tan: Item# Description: Qt: <br /> Dental Waste,• <br /> Amalgam:Slze QtyFixer:Size QtyDeveloper:Slze Qty <br /> Lead:Size Qt Other:Size Qt <br /> Other:Type Slze Qt <br /> Notes' ours: - T _ ri 8:3[1 Q <br /> Generator Certification: I herebycertify that thecontents of this consignment are fully and accurately described above by proper shlpping 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 /> further declare that this shipment of waste Is freaUons. Z as as a the US codeof federal <br /> regylati ns and/or ropria a state nates and re1 <br /> Generator(Customer) i L xJ-z2•!5" <br /> Name of authorized person(print) Signature fDDate <br /> Route Driver tiq4 2 -2 2-—/:;— <br /> Name <br /> /5Name of auttbrized person(print) f� Signa Date <br /> -.erdficate of Destruction Brett Espicha Y 'U JUN �Q <br /> t 5 20b <br /> Incineration Name of authorized person(print) _ Sign ure Dto <br /> Certificate of Destruction Brett Espicha �13�VS <br /> Autoclaved Name of authorized person(print) Signature Date <br />