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13amett Medical Services, Inc 510-429-9911 Ph Date: 05127/21115 <br /> 3670 JEnterprise Ave 510-266-0945 Fax Manifest : 77343 <br /> Hayward Ca 94545 Customer# 2232 <br /> EPA#CAL000404096 <br /> TransportertD#4891 <br /> lerator: Contact: Sally Solanki Worit:(209)466-262F <br /> Stockton Hematolociv 011ocoloetV - Stocki weekly <br /> 2020 N Callfarnla St,Ste#? Frequency of Service <br /> Stockton,,CA 95204 Pricing $950 a nut. <br /> ❑Transfer Facility: W Destination Facility: mate Transfer Facility Alternate'Destinatlon Facility O Destination Facility <br /> Daniels SharpsmarllBMS Barnett Medical Servlces,inc Daniels Sharpsmarf �fiCurtis Bay Energy Photo Waste Recycling Inc <br /> 3670 Enterprise Ave 2385 Arch Rd#200 4144 E.Therese Ave 3200 Hawkins Point Rd 2980 Kamer Blvd#C <br /> Hayward CA 94545 Stockton CA 95215 Fresno CA 93725 Baltimore MD 21226 San Rafael CA 94901 <br /> (510)429.9911 (510)429.9911 559.834-6252 (410)354-3228 (415)459.8807 <br /> Permit#TS/OST-106.� Permit#TSIOST-55 Permit#2005•WMI-0036 Permit#PWR 122764 <br /> Date _Date Jam(l y— <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG N <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 /> 2gal 20gal 8gal gal <br /> 4gal 38 gal "Z 77-0 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 /> ;al Size Qty Weight Product Delivered; <br /> Weight: Pathogen: Item# Description: Qt: <br /> Dental Waste: <br /> Amalgam:Size Qty Fixer:Size Qty Developer:Size Qty <br /> Lead:Size Qt Other:Size Qt <br /> Other:Type Size Qt <br /> Notes: ou .,, ri 8:304 <br /> Generator Cerflflcatlo n: I hereby certify that the contents of this consignment are fully and accurately described above by proper shipping 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 /> I further declare that this shipment of waste Is free of hazard and mercurywaste as defined by the US codeoffederal <br /> regu tions and/or appropriate state nAes an ulatlons. <br /> Generator(Customer) r/lG ( <br /> Name of authorized person(print) Signature Date <br /> Route Driver 5--9--7-15— <br /> Name f.4 <br /> 15— <br /> Nameofau orizedperson(print) Signa Date <br /> Certificate of Destruction Brett Espicha —� JOL 3 0 2015 <br /> Incineration Name of authorized person(print) )) Sr�i,,�,, ur Da e <br /> Certl fiesta of Destruction <br /> Brett Espichau ����t <br /> Autoclaved Name of authorized person(print) Signature Date <br />