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From-New Hop® Post Acute Care 209 832 2273 11/10/2016 07:32 0015 P.006/014 <br /> 1p <br /> Daniels Sharpsmart Inc. Tet: 559-834-6252 Manifest#: 758050 <br /> 4144 E Therese Ave Fax:559-834-2242 Customer#: 1686 -11 <br /> Dan- • . Fresno, CA 93725 <br /> Cels For Chemical Emergency Date: Sep 01,2015 <br /> "�""o"'°""��•sd" Spill,Leak,Fire,Exposure,or Accident Tuesday-610 <br /> Cali CHEMTREC Day or Night lllll11118 111(�{�� ) <br /> 1-800-424-9300 7 5 8 0 5 0 <br /> Generator: Carrier: Transporter Permits: <br /> State ID No.: Daniels Sharpsmart, Inc. CA-4707 <br /> New Hope Post Accute Care 111 W Jackson Blvd EPA#CAL000344393 <br /> 2586 Buthmann Ave Suite 720 <br /> Tracy CA 953762165 Chicago,IL 60604 US DOT#1295076 <br /> Attn:D 312-546-8900 <br /> (20 Vehicle Decal: <br /> WTS/OST-55 <br /> ity: Alternate Destination Facility Transfer Facility: <br /> harpsmart 1 Curtis Bay Energy Daniels-Fresno Plant <br /> herese Ave 3200 Hawkins Point Road 4144 Ea rese <br /> A 93725 Baltimore.MD 21226 Frei A 93725 Transfer ftplij t S6njlu ��aIw <br /> 6252 one: 443-692-2300 Phone: �1 PZo <br /> 55 Permit#: 2005-WMI-0036 Permit#: S S�� ►�� p� �� <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s 6.2 PG Il OR <br /> Material Type <br /> Type tqt( Net Wt. Type 9ty Net Wt. ?YP—e Net Wt. (Circe One Plr Line) Totals <br /> S14 S14PH BOX Bio/Path/Pharm/Chemo Total R7 Containers: <br /> S22 822PH BOX Bio/Path/Pharm/Chemo <br /> S32 S32PH 28 GAL Bio/Path/Pharm/Chemo <br /> S14A+ S22PHA+ 28 GAL Bio/Path/Pharm/Chemo Estima d Gross wt <br /> S22A+ S32PHA+ 31 GALto/Path/Pharm/Chemo (at pickup): <br /> S32A+ S64PHA+ 43 GAL Bi /Path/Pharm/Chemo <br /> S64A+ C22 43 GAL to/Path/Pharm/Chemo <br /> M64 C64 96 GAL Bio/Path/Pharm/Chemo RMW Actual Net Wt: <br /> 96 GAL Bio/Path/Pharm/Chemo <br /> Sharpsmart Containers: <br /> 200 GAL Bio/Path/Pharm!Chemo ? <br /> Surgical Blue Wrap <br /> Estimated Gross Wt(At Pickup): Bale/Bag Bio!Path/Pharm/Chemo <br /> Sharpsmart Actual Net Wt: <br /> Transporter ID's Returned: (LG) (MED) (SM) <br /> Clean Products Delivered: _ <br /> Product: Ordered: Oly Dolly r d: --------•--•--•---___.___._� <br /> Minimum Comments or Discrepancies: <br /> Pick Up/Stop Charge 1.00 <br /> 43 GAL 1.00 <br /> I <br /> J Bulk Pharmaceutical,Trace Chemo,end/or Pathological waste <br /> I�consolidated on transfer Manifest# <br /> i Date: Load# <br /> Generator Certification: I hereby declare that the content of this consignment are fully and accurately described above by proper shipping name and are <br /> classified,packed,marked,and labeled,and are In all aspects In proper condition for transport according to applicable government <br /> ra ulations. <br /> I further declare that this shipment of waste is free of he-., us and mercury waste as defined by the US code of federal regulations <br /> andl propnate slate rules and regulations. <br /> Generator(Customer): `k - h f / <br /> Route Driver: a fCf�pp z d peso (`e1:` 5lg�tu ate <br /> - D <br /> G <br /> (If Applicable) Name of authorized person(print) gnature Date <br /> Transfer Driver: � <br /> Name o rued portion(print) Signature Date <br /> Certifica' o eceipt of waste as cove this manifest number. <br /> Gariificate of Receipt: <br /> Name 9&aotbatlzed person(print) Signature Date <br /> Certif nrolceipt and destruction waste as covered by this manifest number. <br /> Certificate of Destruction: ��/� (� t _ 1 <br /> Name of authorized person(print) Signature Date <br /> White Canary Pink Gold <br /> Certificate of Destruction-Return to Customer Daniels Destination Facility Customer <br />