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1 <br /> I r <br /> Daniels Sharpsmart Inc: Tel: 559-8346252 Manifest#: 712087 <br /> 4144 E Therese Ave x:559-8342242 Customer#: 10232 <br /> Fresno CA 93725 Old Location# <br /> Daniels- For Chemical Emergency Date: Apr 19,2013 <br /> ta3t;rr�Ha3flh".&+e SatE' Spill,Leak,Fire,Exposure,or Accident Friday-606 <br /> Call CHEMTREC Day or Night t�Illllll'11���I��I��11I �11 <br /> 1-800-4249300 7 1 2 0 8 7 <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 /> i 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 /> If Fresno CA 93725 Anahuac TX 77514 Incineration Signature&Date: Paramount,CA 90723 Transfer Signature&Date: <br /> i Phone: 559-834-6252 Phone: 409-267-3913 Phone: 661-600-4368 <br /> i Permit M TS/OST-55 Permit#: NSW2239-A Permit# 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 ft Net Wt. Type City Net Wt. Type (�jt( Net Wt. Type Net Wt. <br /> S14 S14PH _ 28 GAL <br /> S22 � 522PH AL <br /> 4�— <br /> S32 S32PH GAL SubTotal <br /> S14A+ S22PHA+ <br /> – Total Containers <br /> J922A+ S32PHA+ SubTotal <br /> -S32A+ S64PHA+ Estimated Gross Lbs <br /> PatholOssY (at pickup): <br /> S64A+ Y SubTotal <br /> Total NET Lbs. <br /> SubTotal <br /> Transporter ID's Returned: (LG) (MED) (SM) <br /> Clean Products Delivered: <br /> Product: Ordered: Qty Delivered: <br /> 38 GAL 10.00 Not Cse Notes or Discrepancies: —_ <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-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 /> I further declare that this shipment of waste is free of hazardous anknercury waste as defined by the US code of federa regulations and/or <br /> approp ate state rules and regulaa <br /> Generator(Customer): ~ <br /> Route Driver: a fa thorized pUlo (print): Signatu e r ` Date <br /> (If Applicable) of a t a o (pr{nt nature Date <br /> Transfer Driver: <br /> Name of authorized person(print) Signature Date <br /> Ce fication of receipt of waste as cove d this manifest number. <br /> Certificate of Receipt: <br /> Name of authorized person(print) Signature Date <br /> Certification of receipt and destruction ante as covered by this manifest number. <br /> Certificate of Destruction: �a,) - _ <br /> r �V <br /> Name of authorized person(print) Signature Dat�— <br /> White Green Canary Pink Gold <br /> Cartiflcate of Destruc:;on Return to Customer Daniels Destination Facility Transporter Customer <br />