Laserfiche WebLink
r --Ak <br /> Daniels Skmartancel SS9834;6252 r Manifest#: X11799 <br /> 4144 E'Therese Avg . =EFarx:55 •834-2242 Customer#: _ 10232 <br /> Fresno CA 93125 old Location# <br /> For,Chentcal Emergency Date: Apr 04,2013 <br /> pill FJ11nce s« x .:; <br /> Exposure,or Accident Thursday.-606 <br /> -alit Day or Night ������ �����{�������������������� <br /> 1800-424-93.00 :" �f 1 <br /> Generator: Carrier: f Transporter Permits: <br /> State ID No.: Daniels "i Transporter <br /> Inc. CA-:4707 <br /> Deuel Vocational Institution 111 W Jackson(31vd EPA#CAL000344393 <br /> 23500 Kasson Rd Suite 720 <br /> Tracy CA 95304 Chicago, i 60604 US DOT#1295076 <br /> Attn. 312=546=8900 <br /> - Vehicle Decal: <br /> Destination Facility: Alternate DestnatAon 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 Si nature&Date: <br /> Phone: 559-834-6252 Phone: 409-267-3913 . Phone 661-600-4368 <br /> Permit#: TS/0ST-55 Permit#: NSW2239-A Permit#: TS/OST-94 _•, <br /> Waste Collected: UN 3291 Regulated Medical Waste d.s 6.2 PG II <br /> Sharusmarf Containers Pharmaceutical Regulated medical Waste Trace Chemotherapy <br /> Tvpe '� : Net Wt. Tvpe Qty i Net Wt: type :' Qy Net Wt. Type � Net Wt. <br /> $14v S14PH 28,GAL <br /> S22PH S GAL <br /> ;532 S32PH 0 GAL SubTotal <br /> 'S14A+ S22PHA+ i, <br /> Total Containers <br /> CA+ <br /> A+ S32PHA+ SubTotal <br /> S64PHA+ -Pathology Estimated Gross Lbs <br /> (at pickup): <br /> S64A+ SubTotal <br /> Total NET Lbs. <br /> SubTotal <br /> Transporter ID's Returned: (LG) (MED) (SM) <br /> Clean Products Delivered: <br /> Product: Ordered: <br /> t QDelivered: Notes Comments or Discrepancies: <br /> 28 GAL 10:00 <br /> 38 GAL 10.00 <br /> Alternate Destination Facility <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-W MI-0036 <br /> Generator CertifiCatiOn: I hereby declare thatthe content of this°consignment are fully,and accurately described above by proper shipping name,and are classified; <br /> packed,marked,and labeled,and are m all aspects in proper condition for transport according to applicable government regulations. <br /> I further declare that this shipment of We is free of hazardous and mercury waste as defined by the US code of fe eral regulations and/or <br /> appropriate,state rules a tl regulations <br /> Generator(Customer):_ . <br /> Name of aut onzediipe n In Date <br /> Route Driver: ) i <br /> (If Applicable) Name of authorized person(print), , Signature Date <br /> Transfer Driver: <br /> Name of authorized person(print) Signature 'Date <br /> Certification of receipt of we as"coveredby"this_manifest number. <br /> Crtif11cate of Receipt: <br /> Name of authorized person(print) Signature Date <br /> Certification of receipt and destruction`of waste as covered';by-ihis manifest number. <br /> Certificate of Destruction: <br /> Name of authorized person(print) Signature Date <br /> White Green Canary Pink Gold <br /> nw ificata of nActnintinn.Rah vn M(`nctnmar naniplc Destination Facility Transnorter Customer <br />