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Barnett Medical Services, Inc 510429-9911 Ph Date: ®5/06/2015 <br /> V 3670 Enterprise Ave 510-266-0945 Fax Manifest#: x3742 <br /> Hayward Ca 94545 Customer# 2232 <br /> EPA#CAL000404096 <br /> 'transporter ID#4891 <br /> lerator: Contact: Sally Solanki Work:(2cr3)466.2&:@ <br /> Stockton Hematatogv Oljocoiogv-Stocki Weekly <br /> 2026 N California Sr.Ste#3 Frequency of Service <br /> Stockton,CA 95284 Pricing $950 a rr*. <br /> 177 Transfer FadiTf. M Destination Facilityornate Transfer Facility Memale Destination Facility 13 Destination Facility <br /> Daniels SharpsmarVBMS Barnett Medical Services,Inc Daniela Sharpsmart )i'— <br /> rtis Bay Energy Photo Waste Recycling Inc <br /> 3670 Enterprise Ave 2365 Arch Rd#200 4144 E.Therese Ave 3200 Hawkins Point Rd 2980 Kerner Blvd#C <br /> Hayward CA 94545 Stockton CA 95215 Fresno CA 93726 Baltimore MD 21226 San Rafael CA 94901 <br /> (510)429.9911 (510)429-9911 559-834.6252 (410)354-3228 (416)459-8807 <br /> Permil#TS/OST-106 Permit#TSIOST 55 Permit#2005-WMI.0036 Permit#PWR 122784 <br /> Date _-� net b .� <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s,6.2 PG 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 /> 4gal 38 gal IV 9gal 18gal <br /> 6 gal 40 gal 12 ga I 20 gal <br /> 8ga) 44 gal 18 gal 38 gal <br /> 12gal Weight <br /> -al Size Qty Weight Product Delivered: <br /> Vveight Item# Description: Qt: <br /> Dental ante• <br /> Amalgam:Size QtyFixer:Size Qty Developer:5ize Qty <br /> Lea d:Slze Qt Other:Size Qt <br /> Other:Type Size- <br /> MOWS. <br /> ize Qt <br /> Notes: - nom_ <br /> Generator Certification: I herebycertify that thecontents of this eonslgnmentare fully and accurately described above by proper slipping narne <br /> and are classified,packed,marked,and labeled,and are In allaspects In proper condition for transport according to <br /> appllcablegovernment regulations. <br /> further declare that this shipment of waste Is free o hazardous mercury waste as defined by the US code of federal <br /> regulations and/or appropriate state Hies an ul <br /> Generator(Customer) <br /> Name of authorized person(print) Slgnatur Date <br /> Route Driver �'q "►�an.�heZ —6—/%j <br /> Name ofaut rzed person(print) Date <br /> fug s o zoa <br /> •t:ertificate of Destruction Brett ESDICha <br /> Incineration Name of authorized person(print) �^Syina ure D to <br /> Certificate of Destruction Brett Espicha �'�'" f j�11 <br /> Autoclaved Name of authorized person(print) signature Date <br />