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UNIVERSITY OF THE <br /> PACIFIC., <br /> Thomas ). 1_.orng, School of! <br /> I'haniiac_v& Health Scicnccst <br /> SHARPS SIGN-OUT SHEET <br /> Date Range: July 1, 2013 —July 31, 2014 <br /> Please Note: This is a LEGAL PROCESS. Your name is a guarantee that all appropriate protocols <br /> have been followed: <br /> 1) You agree to check out and return the Sharps Container and transport tote. <br /> 2) The Sharps Container must hold only what is listed on the label. <br /> You can be charged$10 for any additional items in the Sharps Container you checked <br /> out/in.. <br /> Write legibly and clearly. <br /> Include ALL information requested below. <br /> DATE DATE <br /> SHARPS# QTY NAME PHONE# CHECK OUT CHECK IN <br /> e <br /> 1.4 Qt = Sharps # 201- 300 1 GAL = Sharps # 101 —200 5 Qt= Sharps # 1- 100 3 gal = 300- 400 <br />