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- <br /> Barnett Medical Services, Inc 510-429-9911 Ph Date: 06/17/2015 <br /> ®� 3670 Enterprise Ave510` Manifest#: 77345 <br /> Hayward Ca 94545 266-0945 Fax Customer# 2232 <br /> EPA#CAL000404096 <br /> Transporter iDf14891 <br /> ierator: t! Contact: `;alhr Solanki Work.:t<+C19)4r�6.2n2E <br /> Sd ttockton e"Itr atolp o(IV OnocollE clV- tock( YFeekly <br /> 2420 N Ca►Ifarnta St,ate#3 Frequency of Service <br /> Etorhtan,CA 95244 $950 a rr7.. <br /> Pricing <br /> C1 Transfer Facility: 0 Destination Fadfiity: {p �A <br /> Alternate Transfer Facility llemete Destination Facility O Destination Facility <br /> Daniels SharpsmarVBMS Barnett Medical Service Inc s` 'niels Sharpsmart Curtis Bay Energy Photo Waste Recycling inc <br /> 3670 Enterprise Ave 2385 Arch Rd 4200 4144 E.Therese Ave 3200 Havridns Point Rd 2980 Komar 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 /> Pemtil#TSloST 108 Permit#TSIOST 55 Permit#2005-WMi-0036 PermH#PWR 122764 <br /> Date _Date�&V/s <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 9 gal 18 gal <br /> 6 gal 40 ga 12 gal 20 gal <br /> 8 gal 44gal 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 /> AmalgaIn:Size Qty Fixer:Size Qty Developer:Slze Qty <br /> Lead:Size Qt Other:Size Qt <br /> Other:Type Size Qt <br /> Notes: 1. ) n .0 <br /> Generator Certification: I herebycertify that the contents of this consignment are fully and accurately described above by proper shipping name <br /> and are classified,packed,marked,and)abeled,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 haz ous d me u waste as defined by the US oodeo f federal <br /> regulat' its and or appropriate ate fides end tali s. <br /> Generator(Customer! <br /> ame of aut orized person(print) Signature pate <br /> Route Driver <br /> Name of aut Ized person(print) Sign�J/ Dale <br /> •-Certificate of Destruction Brett Es icha AUG 2 2015 <br /> Incineration Name of authorized person(print) fg lure DaS- <br /> Autoclaved <br /> � ��( <br /> Cert(ffeate of Destne coBrett Espicha qT on ttt <br /> Autoclaved Mame of authorized person(print) Signature Date <br />