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S32A+ S64PHA+ E 9 Lo —IOM <br />S64A+ SubTotal. !�— <br />SubTotal <br />Transporter ID's Returned: (LG} <br />(MED) <br />Clean Products Delivered: <br />Product: <br />Drop off RMW <br />Generator Certification: . <br />Generator (Customer): <br />Route Driverea, <br />I ia <br />(it AppLicagfeTf � <br />Transfer Driver: <br />Certificate of Receipt: <br />Certificate of Destruction: <br />Ordered: Qty Delivered: <br />Ali <br />Lj <br />DEC -2 9 2Q13 <br />CUR <br />)A) D8 13AY Eta' <br />I <br />F <br />Daniels Shallsmart Inc. <br />Tel. 559-834-6252 Manifest #: 721687 <br />4144 E Therese Ave <br />Fax:659-834-2242 Customer fl: 1044 -2 <br />Daniels- <br />Fresno CA 93725 <br />Old Location # <br />f,12I Hwithma safer <br />For Chemical Emergency Date: Dec 12, 2013 <br />Spill, Leak, Fire, Exposure, or Accident Thursday - 626 <br />C511'ghtIIIIIII Day or Night <br />1.800-424-9300 lllillfllfil <br />Illi <br />lflilll <br />lffll <br />rllfll <br />Generator: <br />State 10 Na.: <br />Carrier: Transporter Permits: <br />Daniels Sharpsmart, Inc. - Fresno <br />Daniels Sharpsmart, Inc. CA - 4707 <br />4144 E Therese <br />111 W Jackson Blvd EPA# CAL000344393 <br />Suite 720 <br />Fresno CA <br />Attn: Nick Rosato <br />93725 <br />Chicago, IL 60604 US DOT # 1295076 <br />312-546-8900 <br />(559) 834-6252 <br />Vehicle Decal: <br />Destination Facility: <br />Alternate Destination Facility <br />Transfer Facility: <br />Daniels Sharpsmart Inc, Waste Management <br />Medical Waste Services <br />4144 E Therese Ave <br />7505 State Highway 65 <br />7321 'Quimby St <br />Fresno CA 93725 <br />Anahuac TX 77514 incineration Signature & Date: Paramount, CA 90723 Transfer Signature & Date: <br />Phone: 559-834-6252 <br />Phone: 409-267-3913 <br />Phone: 661-600-4368 <br />Permit 0: TS/OST-55 <br />Permit NSW2239-A <br />TS/OST-94 <br />Sharpsmart Containers <br />Pharmaceutical Regulated Medical Waste Trace ChgM2jtqLM <br />ime Qtv Not Wt. <br />Type 9_t y Net Wt. Type <br />Qty Net Wt. Type Ply Not Wt. <br />— -1 7171i <br />S14 — <br />f <br />1 28 GAL <br />_.4- 4 <br />I , <br />1041f 4i <br />S22 — <br />822PH 38 GAL <br />S32 <br />S32PH 98 GAL <br />SubTotal <br />S14A+ <br />S22PHA+ <br />S22A+ <br />S32PHA+ SubTotal <br />Total Containers > <br />S32A+ S64PHA+ E 9 Lo —IOM <br />S64A+ SubTotal. !�— <br />SubTotal <br />Transporter ID's Returned: (LG} <br />(MED) <br />Clean Products Delivered: <br />Product: <br />Drop off RMW <br />Generator Certification: . <br />Generator (Customer): <br />Route Driverea, <br />I ia <br />(it AppLicagfeTf � <br />Transfer Driver: <br />Certificate of Receipt: <br />Certificate of Destruction: <br />Ordered: Qty Delivered: <br />Ali <br />Lj <br />DEC -2 9 2Q13 <br />CUR <br />)A) D8 13AY Eta' <br />I <br />Estimated Gross Lbs <br />(at pickup): <br />Total NET Lbs. <br />(SM) <br />Notes Comments or Discrepancies: <br />j— <br />r ,6 t ii! , .4 X. E- -, * , lob <br />Alternate Destination Facility <br />.Name: Curtis Say Energy <br />Address: 3200 Hawkins Point Road <br />CitYlStatif/Zip: Baltimore, MD 21226 <br />Phone: 44'3-80-91nn <br />I hereby declare the! 1), I&SIft,,re fully and accurately described above by proper <br />shipping name and are <br />classified, packed, marked, and labeled, and are aspects in proper condition for transport according to applicable government <br />rgulations. <br />further declare that this shipment of waste is free of hazardous and mercury waste as defined by the US code of federal reguiatiom; <br />and/or appropriate state rules and regulations. <br />rizecj person <br />Signature <br />Date <br />Ame of gu Zed,oiersbri (pritit) Signature Date <br />Name of authorized person (print) Signature Date <br />Certification of receipt of waste as covered by this manifest number. <br />Name of authorized person (print) Signature Date <br />Certification of receipt and destruction of waste as covered by this manifest number. <br />Name of authorized person (print) Signature Date <br />White Green Canary Pink Gold <br />Certificate of Destruction - Return to Customer Daniels Destination Facility Transporter Customer <br />F <br />91 <br />Estimated Gross Lbs <br />(at pickup): <br />Total NET Lbs. <br />(SM) <br />Notes Comments or Discrepancies: <br />j— <br />r ,6 t ii! , .4 X. E- -, * , lob <br />Alternate Destination Facility <br />.Name: Curtis Say Energy <br />Address: 3200 Hawkins Point Road <br />CitYlStatif/Zip: Baltimore, MD 21226 <br />Phone: 44'3-80-91nn <br />I hereby declare the! 1), I&SIft,,re fully and accurately described above by proper <br />shipping name and are <br />classified, packed, marked, and labeled, and are aspects in proper condition for transport according to applicable government <br />rgulations. <br />further declare that this shipment of waste is free of hazardous and mercury waste as defined by the US code of federal reguiatiom; <br />and/or appropriate state rules and regulations. <br />rizecj person <br />Signature <br />Date <br />Ame of gu Zed,oiersbri (pritit) Signature Date <br />Name of authorized person (print) Signature Date <br />Certification of receipt of waste as covered by this manifest number. <br />Name of authorized person (print) Signature Date <br />Certification of receipt and destruction of waste as covered by this manifest number. <br />Name of authorized person (print) Signature Date <br />White Green Canary Pink Gold <br />Certificate of Destruction - Return to Customer Daniels Destination Facility Transporter Customer <br />