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Barnett Medical Services, Inc 510-429-9911 Ph Date: 04i29l2015 <br /> ®� 3670 Enterprise Ave 510-266-0945 Fax Manifest : 71958 <br /> Hayward Ca 94545 Customer# 2232 <br /> EPA#CAL000404096 <br /> ierator: Transporter IDfW891 <br /> Contact: Sal r Solanki V40fk:(2N)4E825r <br /> Stockton HeMatoloQV 0110colow - Stockl <br /> weekly <br /> NGalirarnia SET,Ste#3 Frequency of Service <br /> Stockton:CA 95204 . Pricing `950 a wo. <br /> O Transfer Facirar. 0 Destination Facility: emata Transfer Facility eyw'lemato Destination Facility 13 Destination Facility <br /> Daniels SharpsmarVBMS Barrett Medical Services.inc Datdels Sharpsmad Curtis Bay Energy Photo Waste Recycling Inc <br /> 3570 Enterprise Ave 2385 Arch Rd#200 4144 E.Theresa Ave 3200 Hawkins Point Rd 2980 Komer Blvd#C <br /> Hayward CA 94545 Stockton CA 952t5 Fresno CA 93725 Baltimore MD 21226 San Rafael CA 94901 <br /> (510)429-9911 (610)429-9911 559-034-6262 (410)354.3228 (415)459-8807 <br /> Permit#TS/OST 106 Permit#TS/DST-55 Permit#2005•WMI-0036 Permit#PWR 122764 <br /> Date <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s,6.2 PG 11 <br /> Shares Containers Remiated Medical Waste Pharmaceutical Trace Chemotherapy <br /> Size Qty: Size Qty: Wt Size Qty: Wt: Size Qty: Wt <br /> Up to: 3 gal e�A( <br /> 2 gal 20 gal 8 gal 4RV <br /> 4 gal 38 gal - , 0 9 gal 18 gal <br /> 6 gat 40 gal 12 gal 20 gal <br /> 8gal 44 gal 18 gal 38gal Z_ f r <br /> 12 gal Weight <br /> 'al Size Qty Weight Product Delivered., <br /> Weight: P Item# Description: Qt: <br /> Dental Waste: <br /> Amalgam:Size Qty Flxer:Size Qty Developer;Size Qty <br /> Lead:SIze Qt Other:Size Qt <br /> Other:Type Size Qt <br /> Notes: aurs: :, - ri 8.30-4 <br /> Generator Certiffeatbn: I hereby certify that the contents of this consignment are fully and accurately described above by proper shipping nano: <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 /> 1 fu her declare that(hes shipment of waste is free of ar ous mercurywast as tfefined by the US code of federal <br /> re Cations n appropriate state odes and gul <br /> Generator(Cusco med 4 <br /> Marra of uthorized person(pr t) 51gna[we Date/ <br /> Route Driver <br /> Name of author zed rson(print) 5lgaaywe Date <br /> /�11�" JUN 251015 <br /> (-�f <br /> -Certificate of Destruction Brett Espicha `�' <br /> Incineration Name of authorized person(print) _ Sign ere ate J <br /> Certificate of Destruction Brett Espicha I((�19•/In"� ;1 <br /> Autoclaved Name of authorized person Iprint) Signature 'i Date 1 <br />