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(zvp �Barnett Medical Services, Inc 510-429"-9911 Ph Date: 06103/2015 <br /> 3670 Enterprise Ave 510-266-0945 Fax Manifest#: 77 <br /> IHayward Ca 94545 Customer# <br /> EPA#CAL000404096 <br /> Transporter ID#4891 ierator: Contact: Salty Solanki M;k:r?ra)45&2f26 <br /> Stockton Hemato}ociv Onocoiacty -Stock( <br /> 211320N C�allforr�ia St,Ste#3 <br /> Frequency of Service weekly <br /> Stockton.+=A 95204 Pricing $9,6B a rro. <br /> d Transfer Facfflty: Iia DesUnatlon Facility: Allernate Transfer Facility X}Aliamate Destination Facility 13 Destination Facility <br /> Daniels SharpsmarVBMS Barnett Medical Services,lne Kiels Sharpsmart Curtis Bay Energy Photo Waste RMcling 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 Frosno CA 93725 Baltimore MD 21226 San Rafael CA94901 <br /> (510)429-9911 (510)429-9911 559-834-6252 (410)354-3228 (415)459807 <br /> Permiiitt�`#TSIOST-106 Permit#TSIOST-55 Permit#2005-WMI.0036 Permit#PWR 122764 <br /> Dale ) Data�' -� 6 <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG it <br /> Sharps Containers Regulated Medical Waste Pharmaceutical Trace Che otherapx <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 9 gal 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 S,�ze Qty Weight Product Delivered: <br /> Weight: Pathogen: Item#1 Description: Qt: <br /> Dental Waste: <br /> Amalgam:Size Qty Fixer:Size Qty Developer:Size Qty <br /> Lead:Size QllOther:Size Qt <br /> Other:Type Size Qt <br /> Notes: Durs: r; 8:30-1 <br /> Generator Certlfieat(on: I hereby certify that the contents of this consignment are fully and accurately described above by proper shlpping name <br /> and are classified,packed,marked,and labeled,and are In all aspects in proper condition for transpon according to <br /> applicable government regulations. <br /> I further declare that this shipment of waste is free of hazardous and mercury waste as defined by the US oodeoffederal <br /> regulations and/or appropriate state rules and regulations. <br /> Generator(Customer) YM m or go 4sa-,l 0 e0l ` <br /> Name of authorized person(print) Signature Date - <br /> Route Driver6" —J—1ac <br /> Name of aut rized person(print) Sign Date <br /> AUG 2 7 2015 <br /> 'Certif tate of Destruction Brett Espicha <br /> Incineration Name of authorized person(print) S gn cure ate <br /> Brett Espicha '' r <br /> Certificate of Destructlon t9 <br /> Autoclaved Name of authorized person(print) Signature Date <br />