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Barnett Medical Services, Inc 510-429-9911 Ph Date: 07/22/2015 <br /> 3670 Enterprise Ave 510-266-0945 Fax Manifest M --7-7351 <br /> Hayward'Ca 94545 Customer# 2232 <br /> EPA#CAL000404096 <br /> Transporter 10#4891 <br /> nerator: Contact: SMY solanki VAX(209)465.2626 <br /> Stockton Hematolow O"OcologV-St ArCeqkluency of Service �•ra�({it' <br /> 2020 N Caltlomin St,•=its*3 <br /> Stockton,CA 95204 pricing $950 a win. <br /> O Trensfor Fet4ity: M Destination Facility Al4emete Transfer Facility lemate Destination Facility O Destination Facility <br /> Danlets SharpsmaNBMS Barnett Medical Servloes,lnc .1.1.ShorpsmaH e s Bay Energy Photo Waste Recydbg Inc <br /> 3670 Enterprise Ave 2385 Arch Rd 1#200 4144 E.Therese Ave 3200 Hawkins Point Rd 2980 Kemer Blvd NC <br /> Hayward CA 94545 Stockton CA 95215 Fresno CA 93725 Baltimore MD 21226 San Rafael CA N901 <br /> (510)429-9911 (510)429.9911 6511-834-6252 (410)354-3228 (415)4598807 <br /> ParmitT#TS/OST 100 Permit#8 TSIOST 55 Permit N 2005.WMi-0038 Permit N PWR 122784 <br /> Date QX-D.J—"A (,>— <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s.6.2 PG If <br /> S.ljEps Ggntalners Rggulated Medical Waste Pharmaceutical ical Trace Chemotherapy <br /> Size Qty: Size Qty: Wt Slze qty: Wt: Size Qty: Wt <br /> Up to: 3 gal <br /> 2 gal 20 gal. 8 gal 12 gal <br /> 4 gal 38 gales 9 gal 18 gal <br /> 6 gal 40 gal 12 gal 20 gal <br /> 8gal 44 gal 18gal 38 gal ^�� 2® <br /> 12 gal Weight <br /> 'al Size Qty Weight Product N11yered: <br /> Weight: Pathggen,• Item# Description: Qt: <br /> Dental Waste: <br /> Amalgam:Size QtyFixer.Size Qty Developer:Size Qty <br /> lead:Size Qt Other:Slze Qt <br /> Other:Type Size Qt <br /> Notes: ours: iv]-Th 8:30- 2: 0 1-110-6. d 9:30-4 <br /> Generator Certification: I herebycertify that thecontents of this eonsignmentare fully and accurately described above by proper shipping name <br /> and ane classified,packed,marked,and labeled,and are in aliaspects In proper condition for transport according to <br /> applicable government regulations. <br /> I further declarethat this shipment of waste is free ofhaordpus and mercurywaste as by the US codeof federal <br /> regula ors and/ a r ria a state rules ula' s. �J / <br /> GErt@13tOr(Q156Dfi18r� ^_t <br /> N me f authorized person(print} Signa ure Date <br /> Route Driver4 dU7 7-2?,—/5— <br /> Name ofauAwized person(print) Slgna�Qfe' Date <br /> certificate of Destmction <br /> Incineration Name of authorized person(print) Sig ure D to <br /> Certificate of Destruction Brett Espicha Y(!,��i4�� --7 �3 J <br /> Autoclaved Name of authorized person(print) Signature ( Date <br />