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Daniels Sh> mart:lnc Tel 559 834-6252 Manifest#: 712087 <br /> 4144 E Therese•�►ve az:559-834=2242 Customer#: 10232, <br /> Fresno CA 93725 Old Location# <br /> I � For Chemical Emergency Date: Apr 19,2013 <br /> rlmdm�reai a safes Spill,Leak Fire,Exposure,or Accident Friday-606 <br /> fa <br /> ..call CH11RC Day or Night III I I I III 14 <br /> 1- 0Q 424 9300 VIII IIII�� IIt�IlI4II�1III11�I11{ <br /> Generator: Carnes: Transporter Permits: <br /> State ID'No.: Daniels Shorpsmart, 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: 312-546-8906' <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-1 <br /> X 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/OST-55 Permit#: NSW2239-A Permit# TS/OST-94 <br /> Waste Collected: UN 3291 Re ulated Medical Wast4,'A.o.s 6.2 PGA <br /> Sharpsmart Containers Pharmaceutical Regblate'd Medical Waste Trace Chemotherapy <br /> Type �' :Qty ` Net Wt. Type Qty Net Wt. Type Q_yt Net Wt. Type ; Qty Net Wt. <br /> S14 S14PH 28 GAL <br /> S22PH GAL <br /> 532 S32PH 'GAL SubTotal <br /> 77 <br /> 7 77 <br /> 'S14A+ S22PHA+'-. <br /> Total Containers <br /> \+ S32PHA+ SubTotal <br /> r, Estimated Gross Lbs <br /> 32A+ = S641PHA+ Pathology (at pickup): <br /> S64A+ SubTptal t ' <br /> Total NET Lbs. <br /> SubTotai <br /> Transporter ID's Returned: (LG) (MED) (SM) <br /> Clean Products Delivered: <br /> Product: Ordered Qtu Delivered: Notes Comments or Discrepancies: <br /> Alternate Destination Facility <br /> Name: Curtis Bay Energy <br /> Address: 3200 Hawkins Point Road T <br /> City/State/Zip: Baltimore,MD'21226 i <br /> Phone: (410)3543228 <br /> Permit# 2005-WMI-0036 <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 /> G I further declare that this shipment of waste is free of hazardous an emury waste as defined by the US code of feder I regulations andlor <br /> approp late state rules and regulati { <br /> rnGenerator(Customer): _ f <br /> Name of aut orized person,IPnnt) Signature. Date <br /> y q. <br /> Route Driver. fi , � w _ ,. <br /> (if Applicable) Name of authorized person tpnnt) Signature Date <br /> Transfer,Driver: ' >. <br /> Name of auth�tiii0 persori.(prtnt) Signature Date <br /> Certification of receipt of waste as coveredtby this manifest number., <br /> Jficate of Receipt: <br /> Name of authorized person(pant) Signature Date <br /> Certification of receipt and destruction of waste as covered by this manifest number. <br /> Certificate of Destruction: <br /> Name of authorized person tprint) Signature Date <br /> White Greerr' Canary Pink, Gold <br /> Cartificata of nactn,rtinn-Rr turn to fluctnmar Danieli Destination Facilitv Transporter Customer <br />