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r <br /> Daniels Sharpsmart Inc. Tel: 559-834-6252 Manifest#: 712464 <br /> Y;'f::• <br /> `�-.� .;;;: 4144 E Therese Ave Fax:559-834-2242 Customer#: 10232 <br /> Fresno CA 93725 Old Location# <br /> Daniels For Chemical Emergency Date: May 03,2013 <br /> r.ta6 na,�s3u.r.�e sate- Spill,Leak,Fire,Exposure,or Accident Friday-606 <br /> Call CHEMTREC Day or Night <br /> 1-800-424-9300 1 1 I I1u�1II��II1II� I111IAII11II'1 <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 /> ( I - 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: 661-600x4368 <br /> Permit M TS/OST-55 Permit#.- NSW2239-A erm-1U* TS/OSt-* <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s 6.2 PG II <br /> Sharpsmart Containers Pharmaceutical Regulated Medical Waste Trace Chemotherapy <br /> Type Qq Net Wt. Type C yt Net Wt. Type Q_yt Net Wt. Type Q_yt Net Wt. <br /> S14 �_ 28 GAL is <br /> S22 S22PH __ GAL <br /> S32 a� S32PH 96 GAL SubTotal <br /> S14A+. S22PHA+ _ <br /> w Total Containers <br /> S22A+ S32PHA+ SubTotal <br /> Estimated Gross Lbs <br /> -32A+ S64PHA+ Pathology (at pickup): may. <br /> r� iicku <br /> 'JS64A+ SuloTotai �_ 1 3 f.•-� <br /> Total NET Lbs. <br /> SubTotal <br /> Transporter ID's Returned: (LG) (MED) (SM) <br /> Clean Products Delivered: _ <br /> Product: Ordered: Qty Delivered: Notes Comments or(D(iscrepancie <br /> 28 GAL 7.00 4-0 r I t,}• <br /> -M, <br /> Alt r' a e tt IRAINAIty <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 furtqar de arehat this ship ent of waste is ree of hazardous a d rp rc w ste m by th S code of federal regulations and/or <br /> P- ra dat at I od-r la' <br /> Generator(Customer): <br /> Route Driver. <br /> Name of authorized erson(pri t): S grata /_ Date <br /> �f � <br /> (It Applicable) / me f auth z pe o pri t) S t Date �! <br /> Transfer Driver: [ <br /> Name of authorized p n(print) - � Signature Date <br /> e ' piton of ceipt f we as covered by this manifest nurrLber. <br /> Certificate of Receipt: <br /> Name of authorized person(print) Signature Date <br /> // Certification of receipt and destruction of waste as covered is manifest number. <br /> ;ertificate of Destruction: C '"r _ S ~7't <br /> Name of authorized person(print) Signature Date <br /> White Green Canary Pink Gold <br /> Certificate of Dest;ctior•-RetuT to Customer Daniels Oestination Facility Transporter Customer <br />