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Y` Daniels Sl smart Inc Tel: 559-83 4-6252 Manifest#: 712961 <br /> 4144 E Therese Ave Fax:559-834 2242 Customer#: 10232 <br /> Fresno CA 93725 Old Location# <br /> - � "For GhetrnlcOl mergency Date: May 17,2013 <br /> rtax�r rlealtrre step $ ,Il,Le: Ex osure,or Accident Friday {606 ]] ll <br /> Ar: all-CHEM YR :C D y or Night <br /> 1 '66 4249300 ' <br /> Generator: Carrier: Transporter Permits: <br /> State ID No.: Daniels Sharpsmart, Inc: CA-4707 <br /> Deuel Vocational Institution111 W Jackson Blvd EPA#CAL000344393 <br /> 23500 Kasson Rd Suite 720 <br /> Tracy CA 95304 Ghioago, IL'_ 604 US DOT#1295076 <br /> Attn: 312-546-8900 <br /> f <br /> Vehicle Decal• <br /> 'Destination Facility: Alternate Destination"Facility, Transfer Facility: <br /> Daniels 8harpsmart Inc. Waste Management Medical Waste Services <br /> 4144 8 Therese Ave 7505 State Highway 65 7321 Quimby St <br /> Fresno CA 93725 Anahuac TX 77514 , Incineration"Signature&batel:` "Paramount,CA 90723 Transfer Signature&Date: <br /> Phone: 559-834-6252 Phone: 409-267-3913 Phone: 661-6D0-4368 <br /> Permit h: TS/OST-55 Permit#: NSW2239-A Permit# TS/DST-94 <br /> Waste-Collected: UN 3291 Regulated Medical Wast6ii".b s 6.2 PG W* <br /> SharpsmartContainers Pharmaceutical Regulated Medical Waste <br /> Trace Chemotherapy <br /> "Type Net Wt. Type Net Wt. Type Qty Net Wt. Type Net Wt. <br /> S14 S14PH 28 GAL <br /> S22 S22PHGAL . g' <br /> ,b <br /> 's S32PH 95'GAL" SubTotai <br /> $14A+ S22PHA+ <br /> Total Containers <br /> 4+ S32PHA+ SubTotal <br /> " Estimated Gross Lbs <br /> S32A+ S64PHA+' Pathology (at pickup): <br /> 564A+ SubTotal <br /> , <br /> Total NET Lbs. <br /> SubTotal <br /> Transporter ID's Returned: .(L"G) (MED) (SM) <br /> Clean Products Delivered: <br /> Product:` Ordered: 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 <br /> City/State/Zip: Baltimore,MD 21226 ` <br /> Phone: (410)354-3228 <br /> Permit#. 2005-W MI-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 ailaspects in proper condition for transport according to applicable government regulations. <br /> I further declare that this shipment of waste is free of hazardous an`d mercury waste as defined by the US code of federal regulations and/or <br /> appropriatestate rules and regulations <br /> Generator(Custorner): �.` •" <br /> Name Qf authorized person{print) `; Signature,,., Date ' <br /> Route Driver: r <br /> (if Applicable) Name of authorized person(print) Signature Date*' f <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 /> Name of authorized;person(print) .` Signature Date <br /> Certification of receipt and destruction 4f;waste'as covered by this manifest number. <br /> Certificate of Destruction: <br /> Name of authorized;person(pnnt) Signature z Date <br /> White Green Canary p PnK Gold <br />