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Barnett Medical Services, Inc <br />3670 Enterprise Ave <br />Hayward Ca 94545 <br />1 EPA#CAL000403598 <br />Transporter 10#4891 <br />260 -Sate -Hite Dialvs-Is - Stockton <br />1801 E- March Ln #A <br />Stockton. CA $',2l 0 <br />0 <br />510-429-9911 Ph <br />510-266-0945 <br />Contact, I e- rri <br />Frequency of Service <br />Pricing <br />Date: 12-t 2 6s 2 0 15 <br />Manifest <br />Customer# 2669 <br />wer-': pec -j) <br />a Tranaller Facility. <br />(3 DestInation Facility: a AJIemate Transfer Facility <br />a Alternate Destination Facility <br />co Destination Facility <br />Daniels Sharpsmartmms <br />Barnett Medical Services,ine <br />Daniels Sherpernert <br />Curtis Bay Energy <br />Photo Waste Recycling Inc <br />3670 Enterprise Ave <br />2385 Arch Rd #200 <br />4144 E. ThereSeAVe <br />$200 Hawkins Point Rd <br />2980 Kamer Blvd OC <br />Hayward CA94545 <br />Stockton CA 95215 <br />Fresno CA 93725 <br />Baltimore MD 21226 <br />$W Rafael CA 94901 <br />(510)429-9911 <br />(510)429-9911 <br />12 gal <br />(410) 354-3228 <br />(415)459-8807 <br />Permlt#TS-125 <br />Permit # TS/OST-1 W <br />Permit # TSIOST-65 <br />Permit # 2006-WMI-003e <br />Permit 4 FWR 122764 <br />- <br />Datel a/r,R- <br />20 gal <br />8gal .44 <br />gal <br />Waste Collected: UN 3291 Regulated Medical Waste n.o.s. 6.2 PG 11 <br />I herebyoertify that the contents of this consignment are fully and accurately described above by proper shipping name <br />ShaMs Containers <br />8gZULqjqdjftfjcaI <br />Waste <br />Pharmaceutical <br />Trace herattiv <br />Size Qty: <br />Size <br />Qty: Wt <br />Size Qty: Wt: <br />Size Qty: Wt <br />Up to: <br />om <br />authorized person (pr1ptur <br />not Date <br />Route Driver <br />3 gal <br />2 gal <br />20 gal <br />8 gal <br />12 gal <br />4gal <br />38 gal <br />Autoclaved <br />9 gal <br />18 gal <br />6gal <br />40 gal <br />12 gal <br />20 gal <br />8gal .44 <br />gal <br />18 gal <br />38 gal <br />12 gal <br />Weight <br />/—""al <br />Size MY Weight <br />Emduct Delivered; <br />11tem# <br />weight: <br />t n <br />Description: Qt: <br />9-mr <br />Wm <br />� - r -n <br />Arna I garn: Size_ Qty_ Fixer: Slze_Ctty_ Developer: Size_ Qty_ <br />Lead: Size- Ott Other: Size_ Qt <br />Other:Type Size—Qt— <br />Notes: Rours Ba7413 <br />Generator Cert) tion: <br />I herebyoertify 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 inall aspects in proper condition for transport according to <br />applicable government regulations. <br />I further declare that this shipment of waste isfree of hazardousand mercurywasteas defined by the US code of federal <br />regulations and/or appropriate state rules and regulations. <br />Generator (Customer) <br />om <br />authorized person (pr1ptur <br />not Date <br />Route Driver <br />E6 - '85" <br />Name of authorized per on (print) Signat Date. <br />Certificate of Dest ru ctl on <br />Incineration <br />Name of authorized son (print Signature Date <br />Certificate of Destruction <br />!�Slha- V11 6 <br />Autoclaved <br />Name of authorized person (print) Signature Date I I <br />