Laserfiche WebLink
Daniels Sharpsmart Inc. Tel; 669-834-6262 M inifest 751974 <br /> 4144 E Therese Ave Fax:569-834-2242 Ci sistomer M 1946 -62 <br /> Fresno,CA 93725 For Chemical Emergency Di its: May 26,2015 <br /> Tuesday-M <br /> u V100W.Vo Sdar $pili,Leak,Fire,Exposure,or Act: ent <br /> Call CHEMTREC Day or Night <br /> 1-800-424-9300 7 5 1 9 7 4 <br /> Generator: Carrier: Transporter Permits: <br /> State ID No.: Daniels Sharpsmart,Inc. C fk-4707 <br /> SUTTER TRACY COMMUNITY HOSPITA 111 W Jackson Blvd E DA#CAL000W393 <br /> 1420 N Tracy Blvd Pedro Gonzales Suite 720 <br /> Tracy CA 95378 Chicago,It. 60504 US DOT#1295076 <br /> Attn:Heidi-EVS Manager 312-546-8900 V hide Decal: <br /> (209)832-6053 <br /> Destination Facility: Alternate Destination Facility Transfer Facility: <br /> 60anials Sharpsmart Inc. Curtis Bay Energy Daniels-Fresno Plant <br /> 4144 E Therese Ave 3200 Hawkins Point Road 4144 East Therese <br /> Fresno,CA 93725 Baltimore,MD 211226 Fresno CA 93725 Transfer Signature Date: <br /> I <br /> Phone: 559-0346262 Phan 443-692-2300 Phone. <br /> Permit#: TS/OST-55 Perm! 2005-VMI-0036 Permit <br /> Waste Collected: UN 3291 Regula;;;:��—�ste rl.c�3 6.2 PG 11 OR Material Type <br /> Type 0 Ne lft LW-e Not Wh LMe- qLWt, <br /> jqjEgjj2ag P jr Line) 19kill. <br /> S14 S14PH BOX — Bio I Path I Pr arm/Chemo Total RMW Containers: <br /> S22PH Box — Bio/Path/Pt arm/Chemo <br /> S22 Bio/Path/Pt arm/Chemo <br /> S32 S32PH 28 GAL _ _ Blo/Path/Pt arm/Chemo Estimated Gross Wt <br /> S14A+ S22PHA+ 28 GAL — — <br /> S22A+ S32PHA+ 31 GAL _ _ Bio/Path/Pt arm/Chemo (at pickup): <br /> S32A+ S64PHA+ 43 GAL _ — Blo/Path/Pt arm/Chemo <br /> C22 43 GAL _ — Bio/Path/PI arm/Chemo <br /> C654 96 GAL _ — Bio/Path/Plarm I Chemo RMW Actual Net Wt: <br /> P64 96 GAL _ _ BID/Path I P arm/Chemo <br /> 200 GAL Bio/Path/PI term/Chemo <br /> Total Sharpsmart Containers: Bale/Bag Surgical Blue Wrap <br /> Estimated Gross Wt(At Pickup): Bio/Path/P I term I Chemo <br /> Sharpsmart Actual Net Wt: <br /> Transporter ID's Returned: (LG) (MED) (SM) <br /> Clean Products Delivered: <br /> Produ2U Ordered: 91IDelivered: Notes Comments or Discrepancies: <br /> Charge Per Manifest 1.00 <br /> Minimum Pick Up/Stop Charge 1.00 A$ 7VAVA'z-1�6 <br /> Stop Fee 1.00 7 sr-2 7 3 - —e' <br /> - 7 3— <br /> - <br /> S32 PH 6.00 5 7 <br /> Alternate Destination --acII4 <br /> Name: Healthcare Environmental Service Inc. <br /> Address: 142040th )trest NW <br /> City/State/Zip: Fargo NO 8102 <br /> Phone., 701-282-7 73 <br /> Permlitt ITF-208 <br /> Generator Certification: I hereby declare that the content of this consignment are fully and accurately describe I above by proper shipping name and are <br /> classified,packed,marked,and labeled,and are in so aspects in proper condition for tansport 9=rdlng to applicable government <br /> rIka.11,ogs <br /> rf8u blre that this shipment of waste Is freof hazpft1qus dry a waste fined by the US code of federal regulations <br /> r a <br /> ID4iqr appropriate state rules n regulations. <br /> C <br /> Generator(Customer); tj <br /> NMstth Iz dkery- Date 5-,.. <br /> Route Driver: <br /> 1`9Date <br /> (if Applicable) Name of auth9rized person(print) Signature <br /> Transfer Driver: <br /> 14"N Name of authorized person(print) Signature Date <br /> Corti cation of receipt o a covered by this manifest number. <br /> Certificate of Receipt: ro I fv\ P f we", r-ZL-S— <br /> N m -TZ <br /> Nama o authorized person(piritit) Signature Date <br /> Certification of receipt and deMniction of waste as covered by this manifest number, <br /> Certificate of Destruction: *err[�: 5'e�e-'77 e,"V <br /> Name of authorized person(print) Signature Date <br /> White Canary Pink Gold <br /> Certificate of Destruction-Return to Customer Denials Destination Facility Customer <br />