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Barnett Medical Services, Inc 510-429-9911 Ph Date: 055'20/2015 <br /> ®� 3670 Enterprise AveManifest#: 737`t•4 <br /> 510-266-0945 Fax <br /> Hayward Ca 94545 Customer# 2232 <br /> EPA#CA1000404096 <br /> Transporter ID"891 <br /> 'tel Or: Contact: Sall;Solanki Work;r2:75j 465-ZE.26 <br /> oCkton Hetttatolow Onocolociv- Stocki <br /> 2020 IN Galiramla St,Ste#3 Frequency of Service sveFk'' <br /> Stockton,CA 95204 Pricing $060 a r�o. <br /> Q Transfer Facility: IRI Destination Facility: R Anemato Transfer Facility Alternate Destination Facility O Destination Facility <br /> Daniels SharpsmarilBN1S Barnett Medical Services,inc j' Uanfels Sharpsmart 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 Rafael CA 94901 <br /> (510)42&9911 (510)429-9911 559.834-6252 (410)354-3228 (415)459.8007 <br /> Permit#TS/OST-106 Permit#T810ST--55 Permit#2005-WMI.0036 Permit#PWR 122764 <br /> Date —.- Deta /,�— <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6,2 PG ii <br /> Sharps Containers Repulated—Medicall Waste Pharmaceutical Trace Chemotheranv <br /> Size Qty: Size Qty: Wt Size Qty: Wt: Size Qty: Wt <br /> Up to: 3 gal <br /> 2 gal 70 ga l 8 gal 12 gal <br /> 4gal 38 gal /a 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 /> ;al Size Qty Weight Product Delivered: <br /> Weight: Pathoiten: Item# Description: Qt: <br /> Dental Waste: <br /> Amalgam:Size Qty Fixer:Size Qty Developer:Slze Qty <br /> lead:Size Qt Other:Slze Qt <br /> Other:Type Size Qt <br /> Notes. - <br /> Generator Certification: I herebycerllfy that thecontents of this consignmentare fully and accurately described above by proper shipping narne <br /> and are classified,packed,marked,and labeled,and are in allaspects In proper condition for transport according to <br /> applicable government regulations. <br /> I further declare that this shipment of waste Is free of he r and r ry waste as def by the US code of federal <br /> regulations and or appy riate state rules ula' S. <br /> Generator(Customer) <br /> 1496fe of authorized person(print) Signature Date <br /> Route Driver k✓ -a-D-I S`' <br /> Name of horized person(print) Sign Date <br /> Certificate of Destruction Brett Espicha <br /> sol JUL 3 0 2015 <br /> Incineration Name of authorized person(print) S,ig ture � pate <br /> Certificate of Destruction Brett Espicha (Ys l((at (5' <br /> Autodaved Name of authorized person(print) Signature Date <br />