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. Daniels S smart Inc, Tel: 559 lid -6252 Manifest#: 712242 <br /> 4144 E Th a Ave Fax:559--8 2242 Customer M 10232 <br /> Fresno CA 93725 Old Locatian# <br /> For Chemicai,Emergency Date: Apr 26,2013 <br /> raaicr Fie�lU1&9 sit S <br /> =_> � p als, ir¢;+Exposure,or Friday-606 <br /> ill Le <br /> _ fi Gall CHItF t Day or Night <br /> t* 1 $QO-424-93Di1 "" ���I�I,�III�I�II�II�I�I�I�III�I��I <br /> ,aerator: Garner: Transporter Permits. <br /> State ID No.: Danielsharpsmart,-Inc: CA-4707 <br /> Reuel Vocational institution 11,11 W Jackson Bivd EPA#CAL000344393 <br /> 23500 Kasson Rd Suite <br /> Tracy ' CA 95304 Chicago,)L,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 65 732,1 Quimby St <br /> Fresno CA 93725 Anahuac TX 77514 Inan`eratfon Signature&Date Paramount,CA 90723 Transfer Signature&Date: <br /> Phone: 559=834 6252 Phone: X409-267-3913 Phone 661-600-4368 <br /> Permit#: ;r TS%OST-55 Permit#: NSW2239-A, <br /> Waste'Collected: UN 3291 RegulatedWas,Medical Wan:o.s 6.2 PG II <br /> Sharpsmart Containers Pharmaceutical "ulated Medical Waste Trace Chemotherapy` <br /> Type Qtj Net Wt. Type ty Net Wt. TVpe Net Wt. Type Oty Net Wt. <br /> ;.S14 S14PH :28 GAL <br /> S22S22PH 38 GAL <br /> `- <br /> S32° S321PH SubTotal <br /> S�4A+ S22P1-14 <br /> Total Containers <br /> A+ S32PHA+ UbTotal <br /> Estimated Gross Lbs <br /> q+ _ S64PHA+ Pathology (at pickup): <br /> A+ <br /> SubTotal = - <br /> ® Total NET Lbs.;:. <br /> SubTotal _ <br /> Transporter ID's Returned: (LG)` " (MED) (SM) <br /> -Clean Products Delivered: <br /> Product:` 'Ordered: QtDeliyered: Notes Comments or Discrepancies: <br /> 28 GAL. 07 0 <br /> s <br /> Alternate Destination Facility <br /> b <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,afl.,aspacts in proper condition for transport according to applicable government regulations. <br /> I further declare that this shipment of waste'is free of hazardous and,"mercury waste as defined by the US code of federal regulations and/or <br /> approp'nate state rules d regulations. _ <br /> Generator(Customer): ell <br /> Name of authorized (print) Signature " Date <br /> Route Driver: <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 wate'as covered by this manifest number, <br /> rtificate of Receipt: <br /> ' Name of authorized person(print) 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(pnnt) Signature Date <br /> UVhite Green CanaryPink Gold <br /> � rfi,¢ate of perdtii Retgrm to Customer`, Daniels Destination Facility Transporter'; Customer <br />