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Barnett Medical Services, Inc 510-429-9911 Ph Date: 05/13/2015 <br /> ZIP *, <br /> 30620 San Antonio St 510-429-9914 Fax Manifest#: 73233 <br /> Hayward Ca 94544 Customer# <br /> TransporteriDff469t " <br /> lerator: Contact: Salk,So)anki W6Ik:(209)458.2626 <br /> Stockton HerriatologV Olit3eolociV -:Mock-' r4ee ly <br /> 2620 N California St,Ste 93 Frequency of Service <br /> Stockton,CA 95204 Pricing $960 a rro" <br /> o Transfer Facility: CA Destination Facility: Alternate Transfer Facility ❑ Destination Facility bCAltemate Destination Facilith/Mlemale Transfer Facility <br /> 8ame[t Medical Services,lne Barnett Medical Services,tne oalihwise Services Photo Waste Recycling Inc Curtis Bay Energy Daniels Sharpsmad <br /> 30620 San Antonio St 2385 Arch Rd#200 4860 E.Lincoln Ave 2880 Kerner Blvd#C 3200 Hawkins Point Rd 4144 E.Therese Ave <br /> Hayward CA 94544 Stockton CA 65215 Fowler CA 93625 San Rafael CA 94901 Baltimore MD 21226 Fresno CA 93725 <br /> (510)429.9911 (510)429-9911 559-834.3333 (415)459-8807 (410)354-3228 559.834-6252 <br /> Permit N TS-87 Permit#TS/OST•106_ Permit#TS-89 Permit#PWR 122784 Permit#2005-WMI.0036 Permit N TSIOST-55 <br /> Date `oats 5 13'15 <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o,s,6.2 PG II <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 j - 9 gal 18 gal <br /> 6 gal 40 gal, 12 gal 20 ga I <br /> 8gal 44 gal 18 gal 38 gal �- <br /> 12 gal Size Qty Weight <br /> jal Pathogen: Product Delivered: <br /> Weight: Item#i Description: Qt: <br /> Dental Waste: <br /> ArnaIgom:Slze Qty Fixer:Size Qky Developer:Size Qty <br /> Lead:Size Qt Other:Size Qt <br /> Other:Type Size Qt <br /> Notes: ours: - 6 6:30-41 <br /> 0 r pmt +,0 Ccw sot fl , <br /> WS 45�t�.rjD c4i►'1�-�c+tr1C/'�. <br /> Generator Certification: I hereby certify that the contents of this con sgnmentare fully and accuratetydescdbed above by proper shipping name <br /> and are chssifle-d,packed,marked,and labeled,and are In all aspects in proper condition for transport according to <br /> applicable gotiernmentreguiations. <br /> Ifurtherdeciare that this shipment ofwaste Isfreeofh r use mercuryw to define ythe UScode offederal <br /> regpla onsa d/ a r priatestate rules and regutati ns. <br /> Generator(Customer) S-8 <br /> Generator <br /> Narne of authorized person(prat) Signature ate <br /> Route Driver 2 --_-- ----- — 15-/-3-/'15- <br /> Name <br /> /'15-Name of au prized person(print) � Sgna Date — <br /> ,50,� <br /> �-CertificateofDestruction-- Brett Esoicha --�' '"' _ — — JOL_3 a 2015 — <br /> Incineration Name of authorized person(print) („ 5rg�n tutu D to <br /> Certificate of Destruction Brett Es icha <br /> Autodaved Name of authorized person(print) Signature Dat C* <br />