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®R <br /> r4 Daniels Sharpsmart Inc. Tel: 559-834-6252 Manifest#: 709615 <br /> 4144'E Therese Ave Fax:559-834-2242 Customer#: 10232 <br /> Fresno CA 93725 Old Location# <br /> tt��ti�'S For Chemical Emergency, Date Jan 11,2013 <br /> Spill,Leak,Fire,Exposure,or Accident Friday,-606 <br /> ~ 1-800-424-9300 <br /> C Day or Night III�IIIIIIII�I�A�II��I�II�� <br /> 7 0I9 6 1 5. <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: <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: 661.600-4366 <br /> Permit#: TS/0ST-55 Permit#: NSW2239-A Permit#: TS/OST-94 <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s 6.2 PG II` <br /> Sharpsmart Containers Pharmaceutical Regulated Medical Waste Trace Chemotherapy <br /> TVae 0tv Net Wt. Type Cty Net Wt. Tvae (�.,ty Net Wt. Type t3yt Net Wt. l <br /> S14 S14PH 28 GAL <br /> S22 i S22PH _ �/ GAL <br /> 532 S32PH t 96 GAL SubTotal <br /> S14A+ S22PHA+ <br /> Total Containers <br /> 322A+ S32FHA+ SubTotal <br /> Estimated Gross Lbs <br /> _—=S32A+ _ S64PHA+ Patholotw (at pickup): <br /> S64A+ _.,.� ._. SubTotal Total NET Lbs. <br /> SubTotal <br /> Transporter ID's Returned: (LG) __ _ (MED) (SM) <br /> Clean Products Delivered: <br /> Product: Ordered: City Delivered: F�-- --_-- --^- --V-�-----------i <br /> Notes Comments or Discrepancies: <br /> 28 GAL 10.00 <br /> k <br /> Alternate Destination Facility i <br /> Name: Curtis Bay Energy <br /> Address: 3200 Hawkins Point Road <br /> City/State/Zip: Baltimore,MD 21226 I <br /> Phone: (410)354-3228 <br /> Permit#: 0055-W MI-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 shipment of waste is free of hazardous and mercuIF-iry w to as defined by the US code of fedQral regulations and/or <br /> -app pnate state-rules d re Mations. .. ! / <br /> Generator(Customer): <br /> ams of authprige¢person rtrEi};� Si na urs /7) r Date <br /> Route Driver: <br /> �,..la( C-'0 <br /> (If Applicable) fI ` N e ers t) Signa Date <br /> Transfer Driver: - <br /> a e of auth ized p o (prjnt) Signature Date <br /> fic ion of ceip f e as cov ed by this manifest numbs <br /> qD <br /> Certificate of Receipt: _ <br /> NaN.. `th ized pers n(print) Signature Dat <br /> Ce'ffcati of receipt and estructste as covered by this manifest number. <br /> Certificate of Destruction: io <br /> Name of authorized person(print) Signature �- .~r^� -� Date <br /> White Green Canary Pink Gold <br /> Ce,tfficate of Dest-uction-Return to Customer Daniels Destination Facility Transporter Customer <br />