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Barnett Medical Services, Inc 510-429-9911 Ph ®ate: ' <br /> 3670 Enterprise Ave 015 <br /> 510-266-0945 Fax Manifest#:O8/t X7345 <br /> Hayward Ca 94545 Customer# 232 <br /> EPA#CAL000404096 <br /> TransporterlD#4891 <br /> ierator: Contact: <br /> Sally Solanki Worst'(209)466.26226 <br /> Stuchton Hematology Onocologv -StPtmhbency of Service v+eekly <br /> 2020 Id CB11ornia st,Ste#3 <br /> Stockton,CA 95204 Pricing $950 a rno. <br /> O Transfer Facility: l9 Destination Facility: ornate Transfor Facility f�Allemate Desiirwstbn Facility O Destination Facility <br /> Daniels SherpsmartBMS Barnett Modica)Services,lnc Aanal,ls Sharpsman Curtis Bay Energy Photo Waste Recycling Inc <br /> 3570 Enterprise Ave 2385 Arch Rd#200 4144 E.Therese Ave 3200 Hawkins Point Rd 2980 Kerner Blvd#C <br /> Hayward CA 94545 Stockton CA 95215 Fresno CA 93725 Baltimore MD 21226 San Rafael CA 94901 <br /> (510)429.9911 (510)429-9911 559-834.6252 (410)354-3228 (415)459-8807 <br /> Permit#TSIOST-106 Permit#TSIOST-55 Permit#2005-WMI-0036 Permit#PWR 122764 <br /> Dale nate� � <br /> Waste Collected: UN 3291 Regulated Medical Waste n,o.s.6.2 PG II <br /> Shams Containers Regulated Medical Waste Pharmaceutical Trace Chemotherapy <br /> Size Qty: Size Qty: Wt Size qty: Wt: Size Qty: Wt <br /> Up to: 3 gal <br /> 2 gal 20 gal 8 gal 12 gal <br /> 4 gal 38 gal �_ /� 9 gal 18 gal <br /> 6 gal 40 gal 12 gal 20 gal <br /> 8 gal 44 gal 18 gal 38 gal <br /> 12 gal Weight <br /> ,al Size Qty Weight Product 9glivered: <br /> Weight: Pathogen: Item# Description: Qt: <br /> Dental Waste: <br /> Amalgam:Size Qty Fixer:Size QtyDeveloper:Size Qty <br /> Lead:Size Qt Other:Size Qt <br /> Other:Type Size Qt <br /> Notes: Hours: ivt-Tip$:30-12:30 11,30-5, ri 8:3D-4 <br /> Generator Certification: 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 /> further declare that this shipment of waste Is free of hazardous and mercury waste as defined by the US cod eof federal <br /> regulations and/or appropriate state rules and regulations. <br /> Generator(Customer) �Q11A ��ri�� CJ- �0 --- &io IS" <br /> Name of authorized perspflnnt) Signature �— Da/ten <br /> Route Driver [ / �'— <br /> Name of aut orized person(print) Sign Date <br /> Certificate of Destruction Brett Esplcha AUG �a1J <br /> Incineration Name of authorized person(print) Sig lure ato <br /> Brett Espicha <br /> Certificate ofDestcuctlon _ t <br /> Autoclaved Name of authorized person(print) Signature Date <br />