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x Daniels Sharpsmart Inc. Tel: 559-834-6252 Manifest M 711799 <br /> sw 4144 E Therese Ave Fax:559-834-2242 Customer#: 10232 <br /> Fresno CA 93725 Old Location# <br /> Daniels For Chemical Emergency Date: Apr 04,2013 <br /> Spill,Leak,Fire,Exposure,or Accident Thursday-606 <br /> Call CHEMTREC Day or Night <br /> 1-800.4249300 7 1 1 7 9 9 <br /> Generator: Carrier: Transporter Permits: <br /> State ID No.: Daniels Sharpsmart,Inc. CA-4707 <br /> Deuel 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: 661-600-4368 <br /> Permit It. TS/0ST-55 Permit#: NSW2239-A __ Permit#: TS/OST-94 <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s 6.2 PG 11 <br /> Sharpsmart Containers Pharmaceutical Reoulated Medical Waste Trace Chemotherapy <br /> Type Q�yt Net Wt. Type cjyt Net Wt. Type gty Net Wt. Type gt�t Net Wt. <br /> S14 S14PH 28 GAL <br /> S22 S22PH qGAL S32 S32PH GAL SubTotal <br /> S14A+ S22PHA+ <br /> _1 Total Containers <br /> S22A+ S32PHA+ SubTotal 1 <br /> Estimated Gross Lbs <br /> ~' S32A+ r� S64PHA+ Patho120 (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: Qty Delivered: i <br /> 28 GAL 10.00 Notes Comments or Discrepancies: <br /> 38 GAL 10.00 I <br /> i <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 that the content of this consignment are f Ily and accurately described above by proper shipping name and are classified, <br /> packed,marked,and labeled,and are in all aspect in pro er condition for transport according to applicable government regulations, <br /> further declare that this shipment of waste is e of haze and mercury waste as defined by the US code of federal regulations and/or <br /> app nate state rules a gulatio s. <br /> Generator(Customer): f <br /> Name of auth zed person(print): Signature / Date <br /> Route Driver: <br /> (If Applicable) F Na a razed perso (print) St nature Date <br /> Transfer Driver: <br /> Name of authorized person(print) Signature Date <br /> Certifi tion of receiptof ste as covered by this manifest num r. <br /> Certificate of Receipt: <br /> Name of authorized person(print) Signature Date <br /> Certification of receipt and destp4tion vaste as covered by this manifest number. <br /> i <br /> Certificate of Destruction: ca t4 <br /> Name of authorized person(print) Signature Date <br /> White Green Canary Pink Gold <br /> Certificate of Destruction-Return to Customer Daniels Destination F;Acility Transporter Customer <br />