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Barnett Medical Services, Inc 510-429-9911 Ph Date: 06/24/2015 <br /> L 121 3670 Enterprise AveManifest#: 77347 <br /> 510-266-0945 Fax <br /> Hayward Ca 94545 Customer# 2232 <br /> EPA#CAL000404096 <br /> Transporter fD#4891 <br /> lerator: Contact: Sally Selanki V,/OrK:(20)486-2525 <br /> Stockton Heltttatolociv Oi iocolo(jv - Stocks weekly <br /> 2020 N Callrornia St,ace Ara Frequency of Service <br /> Stn ekton.CA. 9521:14 $960 a My <br /> Pricing <br /> Transfer Facility: X Destination Facility: Alternate Transfer Facility (�Alternate Destination Facility O Destination Facility <br /> Daniels SharpsmartlBMS Barnett Medical Services,lne nlels Sharpsmart Curtis Bay Energy Photo MsIG Recycling Inc <br /> 3870 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 CA93725 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/OS7 106 Permit#TS/OST-55 Permitt!2005-WMI-0036 Permit#PW R 122764 <br /> Date �Oate <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG PI <br /> Sharps Containers a utated Medical Waste Pharmaceutical Trace Chemotherapy <br /> Size Qty: Size Qty: Wt Size Qty: Wt: Size Qty: Wt <br /> Up to: 3 ga I <br /> 2 gal 20 gal 8 gal 12 gal <br /> 4gal 38gal L _ �� 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: - , - n 6:301-4 <br /> Generator Certification: I hereby certify tlrat the contents of thisoansignmentare fully and accurately described above by proper shipping name <br /> and are c lassifred,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 haz ou and mercury wste as defined by the US codeof federal <br /> re&ula Ions and/or appropriate state rules and lati S. <br /> Generator(Customer) <br /> Name of authorized person(print Signa} Date <br /> Route Driver a f 1,7c t <br /> Name of autiOrized person(print) Sign Date <br /> 't:erttficate of Destruction Brett Espicha <br /> -�- AUG 2 71055 <br /> Incineration Name oFauthorfzed person(print) ig 4ure Dat <br /> Cerd ficate of Destruction Brett Espicha (���' <br /> Autoclaved Name of authorized person(print) Signature Date <br />