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-A ,� � 0 <br /> y; Daniels Sharpsmart Inc. Tet: 559.834-6252 Manifest#: 709352 <br /> 4144 E Therese Ave Fax:558-834-2242 Customer#: 10232 <br /> Fresno CA 93725 Old Location# <br /> 11aF-I s For Chemical Emergency Dater Jan 04,2013 <br /> Spill,Leak,Fire,Exposure,or Accident Friday-606 <br /> Call CHEMTREC Day or Night IUu�II'�'UIIIIu�Iu�Iitllttll� <br /> 1-800-424-9300 7 0 u 9 u 3u 5 2 <br /> Generator: Carrier: Transporter Permits: <br /> State`ID'No.: Daniels Sharpsmart,'Inc. CA-4707 <br /> Duey Vocational Institution 111 W Jackson Blvd EPA#CAL000344393 <br /> 23500 Kasson Rd Suite 720 <br /> Tracy CA 95304 Chicago, IL 60604 US DOT#1295076 <br /> Attn: 312-546-8900 <br /> ( ) - Vehicle Decal: <br /> Destination Facility: Alternate Destination Facility . _ Transfer Facility: w <br /> Daniels Sharpsmart Inc. Waste Management Medical Waste Services <br /> 4144 E Therese Ave 7505 State Highway 65 7321 Quimby St <br /> Fresno CA 93725 Anahuac TX 77514 incineration Signature&Date: Paramount,CA 90723 Transfer Signature&Date: <br /> Phone: 559-834-6252 Phone: 409-267-3913 Phone: 661.600-4368 <br /> Permit#: TS/0ST-55 Permit#: NSW2239-A _Eermit M TS/OST-94 <br /> Waste Collected: UN 3291 Regulated Medical Waste n,o.s 6.2 PG II <br /> Sharosmart Containers . Pharmaceutical Regulated Medical Waste Trace Chemotherapy <br /> Type ^O yt Net Wt. Type Oty Net Wt. Type Oty Net wt. Typef3 yt Net Wt. <br /> S14 S14PH 28 GAL <br /> S22 _ S22PH 38 GAL <br /> S32 p S32PH GAL A I SubTotal » <br /> S14A+ S22PHA+ <br /> — _"-` Total Containers <br /> �22A•r S32PHA.+ SubTotal <br /> .e.__... ...-_...._ _ Estimated Gross Ltis <br /> o32A+ _M S64PHA+ _ Pathology (at pickup): <br /> S64A+ SubTotal �9 <br /> --- Total NET Lbs. <br /> SubTotal <br /> Transporter ID's Returned: (LG) (MED) (SM) <br /> Clean Products Delivered: <br /> Product: Ordered: Qty Delivered: r- — <br /> Notes Comments or Discrepancies: <br /> 28 GAL 7.00 <br /> Alternate Destination Facility j <br /> Name: Curtis Bay Energy <br /> Address: 3200 Hawkins Point Road <br /> City/State/Zip: Baltimore,MD 21226 <br /> Phone: (410)354-3228 <br /> Permit#: 2005-WMI-0036 i <br /> Generator Certification: I hereby declare that the content of this consignment are fully and accurately described above by proper shipping name and are classified, <br /> packed,marked,and labeled,and are in all aspects in proper condition for transport according to applicable government regulations. <br /> I further declare that this ment of waste is free of ha do nd mercury waste as ed by the U5 code of federal egulations and/or <br /> z l <br /> _ appr pri�tp e to r d r.guiatio_ <br /> Genera$Or(Customer): <br /> am of n :nt _ SI na ut@ Date <br /> Route Driver: <br /> (if Applicable) a eof a t person(print)/ �4� <br /> Date <br /> Transfer Driver: Na of authors pe o' rin gaure Date <br /> cation of re pt of w to ver by Is manifest u r. <br /> Certificate of Receipt: _ <br /> Na e o uthori person(pr _ S g atu& Date <br /> Ce ication of receipt and dest tion Iwar,eascvered by this manifest number. / <br /> Certificate of Destruction: <br /> Name of authorized person(print) Signsture Date <br /> White Green Canary Pink Gold <br /> Certificate of Destruction-Return to Customer. Daniels Destination Facility 'I rar-wporter Customer <br />