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Daniels Sharpsmart Inc. Tel: 559-834-6252 Manifest M 712799 <br /> 4144 E Therese Ave Fax:559-834-2242• Customer#: 10232 <br /> Fresno CA 93725 Old Location# <br /> ❑3Rle'S For Chemical Emergency Date: May 10,2013 <br /> la3kirva+e�n,ce e s Spill,Leak,Fire,Exposure,or Accident Friday-606 <br /> Call CHEMTREC Day or Night ���III�I�11111�'III�� <br /> 1-800-424-9300 7 1 2 7 9 9 <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 /> ( ) - 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 937.25 Anahuac TX 77514 Incineration Signature&Date: Paramount,CA 90723 Transfer Signature&Date: <br /> Phone: 559-834-6252 Phone: 409-267-3913 Phone: 661-600-4368 <br /> Permit#*. TS/OST-55 Permit#: NSW2239-A PermiLit. TS/OST-94 <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s 6.2 PG 11 <br /> Sharpsmart Containers Pharmaceutical Reaulated Medical Waste Trace Chemotherapy <br /> Type Pty Net Wt. Type Qty Net Wt. Type Qty Net Wt. Type Net Wt. <br /> S14 S14PH 28 GAL <br /> S22 S22PH AL _ <br /> S32S32PH 96 GAL U SubTotal <br /> S14A+ S22PHA+ i <br /> Total Containers <br /> I C22A+ S32PHA+ SubTotal <br /> 1 Estimated Gross Lbs <br /> _12A+ S64PHA+ PathO10 (at pickup): <br /> S64A+ __ -- - - SulbTOtal----- <br /> Total NET Lbs. <br /> SubTotal <br /> Transporter ID's Returned: (LG) (MED) _ (SM) <br /> Clean Products Delivered: _ <br /> Pr duct: Ord GAL3 ed:Qty 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 i <br /> City/State/Zip: Baltimore,MD 21226 <br /> Phone: (410 354-3228 <br /> Permit P. 200 IVII-0036 <br /> Generator Certification: I hereby decla,e that the content of this Ansignment 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 w is is free of hazardous and waste. defined the US code of federal regulations and/or <br /> appm" i4 <br /> Generator(Customer): <br /> Name of authorized person print): Signature a Date /® <br /> Route Driver: <br /> (If Applicable) e r t rl derso ri t) ig ur Date <br /> Transfer Driver: 9�-i!3 <br /> Name of authorized person(print) Tgnature Date <br /> Certification of receipt of waste as covered by this manifest number. <br /> Certificate of Receipt: 1111 <br /> Name of authorized person(print) Signature Date <br /> i Certification of receipt and destruction of ste 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 />