Laserfiche WebLink
Daniels Sharpsmart Inc. Tel: 559-834-6252 Manifest #: 723101 <br />` 4144 E Therese Ave Fa:559-834-2242 Customer #: 1044 -2 <br />Fresno, CA 93725 <br />Ba�nh215 For Chemical Emergency Date: Jan 06, 2014 <br />tnawv tlealtttcare srrter Spill, Leak, Fire, Exposure, or Accident Monday -6 j26jj <br />Call CHEMTREC Day or Night I�I��I�I1i111��llllllllllllIllllllll <br />r 1-800-424-9300 7 2 3 1 0 1 <br />Generator: <br />Wil' 28GAL"!-.� <br />GAL <br />Carrier: <br />Transporter Permits: <br />State ID No,: <br />522 <br />Daniels Sharpsmart, [no. <br />CA - 4707 <br />Daniels Sharpsmart, Inc. - Fresno <br />111 W Jackson Blvd <br />EPA# CAL000344393 <br />4144E Therese <br />Route Driver: <br />Suite 720 <br />-} <br />Fresno CA <br />93725 <br />Chicago, IL 60604 <br />US DOT # 1295076 <br />Attn: Nick Rosato <br />312-546-8900 <br />Certificate of Receipt: <br />(559)'834-6252 <br />S22A+ _ <br />Vehicle Decal: <br />Destination Facility: <br />Alternate Destination Facility Transfer Facility: <br />-.. <br />Daniels Sharpsmart Inc. <br />Waste Management <br />Medical Waste Services <br />4144 E Therese Ave <br />7505 State Highway 65 7321 Quimby St <br />SubTotal 4&� <br />Fresno, CA 93725 <br />Anahuac, TX 77514 <br />Incineration Signature & Date: Paramount, CA 90723 <br />Transfer Signature & Date: <br />Phone: 559-834.6252 <br />Phone: 409-267-3913 <br />Phone: 661-600-4368 <br />Permit #: TS/OST-55 <br />Permit #: NSW2239-A <br />Permit #: TS/OST-94 <br />Sharpsmart Containers <br />Pharmaceutical <br />Regulated Medical Waste <br />Trace Chemotherapy <br />Tyne Rty Net Wt. <br />Type Qtv Net Wt. <br />Thr e, Qty Net Wt. <br />lype Qty Net Wt. <br />S14 <br />Wil' 28GAL"!-.� <br />GAL <br />Address: <br />3200 Hawkins Point Road j <br />� -1Y <br />522 <br />S��2,,2��PgH38 GAL <br />443-692-2300 > I <br />Permit #: <br />2005-WMI-0036 �y <br />S32 <br />96 GAL <br />Route Driver: <br />SubTotal <br />-} <br />S14A+ <br />S22PHA+ <br />�a / � <br />me of authorize rpirsokeMnq Signature Date <br />Certification of receipt of waste as covered by this manifest number. <br />Certificate of Receipt: <br />Total Containers <br />S22A+ _ <br />S32PHA+ SubTotal <br />Certification of receipt and destruction of waste as covera rifest number.Certificate <br />of Destruction:Name <br />-.. <br />S32A+ <br />S64PHA+ Pathology <br />Whit. <br />Estimated Gross Lbs <br />(at pickup): <br />S64A+ _ _ _ W, <br />SubTotal 4&� <br />_w1►�� <br />Total NET Lbs. <br />Total <br />r <br />� � <br />Sub'Total <br />- _- <br />Transporter ID's Returned: <br />(LG) (MED) <br />(SM) <br />Clean Products Delivered: <br />Product:r <br />Drop off RMW <br />I d: <br />Notes Comments or Discrepancies: <br />w <br />j,i-u{fi r :G:SX0 (0-X i3 <br />Alternate Destination Facility <br />Name: <br />Curtis Bay Energy j <br />Address: <br />3200 Hawkins Point Road j <br />City/StateRip: <br />Baltimore, MD 21226 <br />Phone: <br />443-692-2300 > I <br />Permit #: <br />2005-WMI-0036 �y <br />Generator Certification: <br />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 />regulations. <br />n e <br />I fur declare 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 gulations. <br />Generator (Customer): <br />'ot_)YO.....r4 —1 f•� �-- V <br />`_- <br />Name of a horized person (print): Signature Date <br />Route Driver: <br />(If Applicable) <br />0"'edlger r�tt Signature Date 4 <br />Transfer Driver: <br />�a / � <br />me of authorize rpirsokeMnq Signature Date <br />Certification of receipt of waste as covered by this manifest number. <br />Certificate of Receipt: <br />Date <br />Name of authorized person (print) Sijbyth' <br />Certification of receipt and destruction of waste as covera rifest number.Certificate <br />of Destruction:Name <br />-.. <br />ofauthoriz erson(print) Signa re Date <br />Whit. <br />r_...-.- n---... n.-.. �._„ <br />