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`� Daniels Sh mart Inc Tel 559 834 6252 ` Manifest M 712464 <br /> 4144 E Therese Ave- Fax:559 834-2242 Customer#: 10232 <br /> Fresno CA 93725 Old Location <br /> Dan <br /> iel " Far Chemical Emergency Date:' May 03,2013 <br /> si i g Sal $p,ll, L� �Fire,Exposure,or Accident Friday-606 <br /> _ Call CHgMTRC Day or Night �II��aI�IIIIIlIIlOIIIIIIIIIIIII�III <br /> 1=800-424 9300 MY ����=>,4<..6cc <br /> Transporter Permits: <br /> Generator: Gamer:. <br /> stateID No.: Daniels Sharpsmart,Inc. CA-4707 <br /> Deuel Vocational Institution 111 W Jackson Blvd EPA#CAL000344393 <br /> 23500 Kasson Rd Suite 726 .'. <br /> Tracy CA 95304 s Chicago,'IL60604 US DOT#1295076 <br /> Attn: 312-546-8900 . <br /> _ - - Vehicle Decal•-- - --- <br /> Destination Facility: _:Alternate Destination F..acility _ rens erFacility: <br /> -" Daniels Sharpsrnart 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 Pone: 409-267-3913 Phone: 661-600-4368 <br /> Permit#: TS/OST-55 Permit#: 'NSW2239-A Permit# TS/OST-94 <br /> " haste Collected: UN 3291 Regulated Medical`Waste`n:os .2 PG 11 <br /> Sharosmart Containers Pharmaceutical Regulated Medical Waste Trace Chemotherapy <br /> Y y� (qty Net Wt. Tvpe Qtr Net Wt: Tripe l�ty Net Wt. Type Net Wt. <br /> S14 28 GAL <br /> S22 S22PH — "— - 3, L— <br /> S32 *r S32PH 96 GAL SubT,�tal <br /> S14A+ S22PHA+ <br /> Total Containers <br /> c29A+ S32PHA+ SubTotal <br /> Estimated Gross Lbs <br /> ��)A+ S64PHA+ Patholoav �, (at pickup): <br /> S64A+ SubTOtal Total NET Lbs. <br /> SubTotal <br /> Transporter ID's;Returned: (LG) (MED) 777 <br /> (SM) <br /> Clean Products Delivered: _ <br /> Product: Ordered: Qtv,Delivered: Notes Comments or Discrepancies: <br /> 28 GAL'; 7.00 �. <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 WM1-0036' <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 shi!ment of waste is free of hazardous and rnercurywaste as efined by t�p US code of federal regulations an or <br /> appropria a sf to rules and gulations # - <br /> Generator(Customer): ..., <br /> Na a of authorized person,(p intra Signate � six, a e <br /> 's-�` '40„ r J' ire'`- `w x .. <br /> Route Driver: � :�. w �� <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 waste as covered by this manifest number. <br /> " �ificate 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(print) Signature, Date <br /> White Green Canary ^^�^^ Pinke„^fir Gostomer <br />