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Daniels Sh mart Cnc Tel: 559 834-6252 Manifest#: 712799 <br /> 4144 E The a Ave Fax:5,59.834-2242 Customer#: 10232 <br /> Fresno CA 93725 Old Location# <br /> Elairl1 - For Cheinical Emergency Date: May 10,2013 <br /> r 09Wrw b fi2itiheac9 sai <br /> Spill, Leo&pja Exposure,or Accident Friday-606 <br /> Call CHEIiIITRC Day or Night 'II�II���IIIIIII�II�I�II'III�II�IIIII�II <br /> 1-800-4249300 1 I F l <br /> Generator: Carrier; Transporter Permits: <br /> State ID NO.: Daniels Sharps art, Inc.- CA--4707 <br /> Deuel Vocational Institution '' 111 W,l'acksoiiBlvd EPA#CAL000344393 <br /> 23500 Kasson i2dSuite 720 <br /> Tracy =_ CA 05304 Chicago,_IL 60604 US DOT#_1295076 <br /> Attn: 312-54 6- . <br /> - Vehicle Decal: <br /> Destination Facility: - ---------Alternate-Destination i=acitity Transfer-Facili <br /> Daniels Sh`arpsmart fnc: Waste Management h71ee is I Waste&ervices <br /> 4144 E Therese Ave 7505 State Highway 65 7321 Quimby St <br /> Fresno CA i93725 Anahuac TX 77514 Incineration Signature&Date .. 'Paramount,CA 90723 Transfer Signature&Date: <br /> Phone: 559-$34-6252 Phone: 409-267-3913 Phone: 661-600-4368 <br /> Permit#: TS/OST-55 Permit#:I NSW-2239-A Permit j: TS/OST-94 <br /> Wast"e Collected: UN 3291 Regulated Medical Waste'n'os .2 PG 11 <br /> Sharpsmart Containers Pharmaceutical Regulated Medical Waste Trace Chemotherapy <br /> Net Wt. Tvpe Q 'Net Wt Tvpe . ; Net Wt. Type Net Wt. <br /> S14, ,,,S14PH 28 GAL <br /> — <br /> S22 S22PHtAL <br /> AL <br /> S32 S32PH SubTotal <br /> S14A+1 S22PHA+ <br /> Total Containers <br /> 'A+" 832PHA+ Suvotal <br /> aA+ S64PHA+ Estimated Gross Lbs <br /> Pathology (at pickup): <br /> S64A+ - SabTofal <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 Discrepancies: <br /> 44 GAL 3.00 <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-WMi 0036 <br /> Generator Certification: I hereby declare that the content of this consignment are fullyand.accurately described above by proper shipping name and are classified, <br /> packed,marked,and labeled,and are'inali aspects in proper condition for transport according to applicable government regulations. <br /> u % wasWas'zfeflnad <br /> appropriate state r les and r gu tions <br /> R_ <br /> Generator(Customer): <br /> Name of au hpers <br /> oriz d on( rmt) Signature Date <br /> Route Driver: G <br /> (If Applicable) 1 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 /> (` �tificate of Receipt: <br /> L� son(print).' Signature Date <br /> Name of authorized per <br /> Certification of receipt and destructiop of waste as covered by this manifest number. <br /> Certificate of Destruction: <br /> Name of authorized person(print) Signature,' Date <br /> White Green Canary Pink Gold <br /> Certificate of Destruction-Return to Customer Daniels; Destination Facility '.:Transporter, Customer <br />