Laserfiche WebLink
Daniels Sharpsmart Inc. Tel: 559-834-6252 Manifest#: 753703 <br /> 4144 E Therese Ave Fax:559-834-2242 Customer 0: <br /> 1044 .2 <br /> Fresno,CA 93725 <br /> For Chemical Emergency Date: <br /> Spill,Leak,Fire,Exposure,or Accident Jun i 22.2015 <br /> I d <br /> Il <br /> iiij <br /> 11 <br /> Call CNEMTREC Day or Night 111101#1111 <br /> 1-600-424-9300 <br /> 7 5 3 7 0 3 <br /> Generator: Carrier: Transporter Permits: - <br /> State ID No.: Daniels Sharpsmart,Inc. CA-4707 <br /> Daniels Sharpsmart,Inc.-Fresno 111 W Jackson Blvd EPA#CAL000344393 <br /> 4144 E Therese Suite 720 <br /> Fresno CA 937268917 Chicago,IL 60604 US DOT N 1295076 <br /> Attn:Russell Daniel 312-546-8900 <br /> (559)573-6095 <br /> Vehicle Decal: <br /> Destination Facility: Alternate Destination Facility Transfer Facility: <br /> Daniels Stiarpsmart Inc. Curtis Bay Energy Daniels-Fresno Plant <br /> 4144 E Therese Ave 3200 Hawkins Point Road <br /> Fresno,CA 93795 Baltimore,MD 21226 4144 East Therese <br /> Fresno CA 93725 -Transfer Signature&Date: <br /> Phone: 559-834-6252 Phone; 443-692-2300 Vitoria: <br /> Permit#: TS/OST-55 Permit N: 2005-WMI-ON6 <br /> Permit 0: <br /> Waste Collected: UN 3291 Regulated Medical Waqqn.o.s 6.9 OG 11 OR <br /> Material Type <br /> TM Qty Not WLTvice 9–ty NILW& LP-9 1910019–fine Per Line) Ul <br /> S14 S14PH Bio/Path lRharm Chemo Total AMW Containers: <br /> S22 S22PH BOX <br /> S32PH BID/Path/0'_�ar Chemo <br /> S32 am <br /> 28 GAL Bio/Oath/Piiiffini/Chema <br /> S14A+ S22PHA+ __L4L_ <br /> S22A+ L28,GAL BID/Path/Pharm/,Cheivio-, Estimated Gross Wt <br /> S32PHA+ 31 GAL BID/Path/Pharm/thei& (at pickup): <br /> 832A+ 564PHA+ 43 GAL BID/Path/Pharm/Chemo –.7 <br /> S64A+ C22 43 GAL BID/Path/Pharm/Chemo <br /> M64 C64 96 GAL <br /> P64 BID/Path/Pharm I Chemo RMW Actual Not Wt: <br /> 96 GAL Blo 14r& Pharm/Chemo <br /> Total Sharpsmart Containers: 200 GAL — — Bio/Path/Pharm/Chemo <br /> Estimated Gross Wt(At Pickup): Bale/Bag _ _ Surgical Blue Wry;; <br /> Sharpsmart Actual Not Wt- — Bio/Path/Pharm Chemo <br /> Transporter ID's Returned: (LG) (MED) (SM) <br /> Clean Products Delivered: <br /> Product: 2Edered, 211291MElt Notes Comments or Discrepancies: <br /> " <br /> L i E, I C <br /> Alternate Destination Facility <br /> Name: Healthcare Environmental Service Inc. <br /> Address: 1420 40th Street NW <br /> CitytStota/Zlp: Fargo ND 58102 <br /> Phone: 701-282-7373 <br /> Permit rrF-208 <br /> Generator,Cortification: I hereby declare that the content of this consignment are fully and accurately described above hv t,�'coer shipping name an�_-, <br /> classified,packed,marked,and labeled,and am in all aspects In Proper condition for transport o'ccu-cing to applicable government <br /> 118Zt'r2.'Lq.re that this shipment of waste Is free of hazardous and mercury waste as defined by the US code of federal regulations <br /> and/or appropriate state rules and reaulatlons. a <br /> Generator(Customer): <br /> Route Driver: Name of authorized person(print): Signature Date <br /> (If Applicable) Name of authorized person(print) Signature <br /> Transfer Driver: Data <br /> Name of authorized person(print) <br /> Certlfl ' on race Sig ure Date <br /> cr, of'receipt of waste as covered by this mmMnIfq3 n' bar. <br /> Certificate of Receipt: <br /> Narrio of authorized person(print) _d Lln��� L Date <br /> Cerfification ol�recelpt and destruction of waste as covered1 *�It <br /> nab <br /> manilost umber. <br /> Certificate of Destruction: <br /> r <br /> White Name of authorized person(print) Signature <br /> Canary Pink Gold <br />