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Barnett Medical Services, Inc 510-429-9911 Pit Date: 07/15/2015 <br /> ®a 3670 Enterprise Ave 510-266-0945 Fax Manifest#: 72330 <br /> Hayward Ca 94545 .4 Customer# <br /> EPA#CAL000404096 <br /> Transporter ID#A897 ' <br /> f :erator: Contact: Sally Solanki Work-,(M)4156-2625 <br /> .-. <br /> "tockton Hematolotly Onocology- StDcki weekly <br /> 2824 iV California 51,Ste#3 <br /> requency of Service <br /> Stockton,CA 45204 Pricing $954 a mo. <br /> C3 Transfer Fad r. M Destination Facility: lemate Transfer Facility O Alto mate Destination Facility O Destnetbn Facility <br /> Dante SharpsmarUBMS Barnett Medical Services.Inc / Daniels Sharpsmart Curtis Bay Energy Photo Waste RocydktQ Inc <br /> 3670 Enlerpnse Ave 2385 Arlt Rd#200 4144 E.Therese Ave 3200 Hawkins Point Rd 2880 Kemw Blvd#C <br /> Hayward CA 94545 Sk x*ton CA 95215 Fresno CA 03725 Baltimore MD 21226 San Rafael CA94901 <br /> (510)429-9911 (510)420-99i1 559-634-6252 (410)354-3226 (415)4598807 <br /> Permit#TS/OST 106 Permit#TSJO5T-65 Permit 9 2005-WMW30 Permit#PWR 122764 <br /> Date <br /> Date <br /> Waste Collected: UN 3291 Regulated Medical Waste mo,s.6.2 PG 11 <br /> 5hams Containers RNWated Medical Waste Pharmaceutical Trace Chemothq= <br /> Size Qty: Size Qty: Wt SizeQty: Wt: Size Qty: Wt <br /> Up to: 3 gal <br /> 2 gal 20 gal 8 gal gal 1 ltJ <br /> 4gal 38 gal Z ZCa 9gal 18 gal <br /> 6 gal 40 gal 12 gal 20 gal <br /> 8 gal 44 gal 18 gal 3$gal <br /> 12 gal Weight <br /> it Size Qty Weight Product _ Ilvered: <br /> VWlght: PathogqM Item# Description: Qt: <br /> Dental Waste: <br /> Arne lgann:Size QtyFixe r:5ize qty Developer:5(ze Qty <br /> Lead:Size Qt Other.Size Qt <br /> Other:Type Size Qt <br /> Notes: Hours: M-Th 8:30-12:30 8:307 <br /> Gert erator Certification: I hereby certify that the contents of this eonslgnmentare fully and accurately described above by proper shipping name <br /> and are classified,packed,ranted,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 hazardous and mercurywaste as def' ed by the US code of federal <br /> regulations and/or appmprlate state rules a gulations. <br /> Generator' ',..._, <br /> Name of authorized persoe4'00-9`- Sipriafiare Date <br /> Route Driver <br /> Name of a rized person(print) Stg Date <br /> n <br /> `CertIflcate of Destruction ' <br /> Incineration Name of authorized person(pnnt) S)g ture Da e <br /> Certificate ofDestrucdon Brett Espicha I(1U� '�'" -7 16[t"r <br /> Autod aved Name of authorized person(print) Signature Date <br />