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Daniels S mart Inc Tel 5 6252 ' Manifest M 713Q74 <br /> ,_ ; <br /> 4144 E The a Ave Fax:55'� 3�-2242=- Customer#: 10232 <br /> Fresno CA 93725 r �` Old l ocation# <br /> raae<,na aeal9 Sal For Cliemrcal Em�ergerfcy Date:` May 24 2013 <br /> er <br /> x � pcll,t_�sak Fi ;Exposure,or Accident {Frliday,-606 <br /> all CHEM TKISC Day or Night I;I�IIII (( IIIIII II [[ <br /> t '1 $00424 9$0 7 II��II1�113IlIIfIII�IIII�I��l��1 !! <br /> Generator: Career ` - s Transporter Permits: <br /> State ID No.: Daniel's.Sharpsmart, in ., f'`: CA-4707. <br /> Deuel Vocational Institution 111 W Jackson Blvd ff' EPA#CA1_000344393 <br /> 23500 Kasson Rd Shite 720 <br /> Tracy <br /> 'CA 95304 Chicago, IL, 60604 US,DOT#1295076 <br /> Attn: 312-546-8900 <br /> ,. . <br /> (. ) a Vehicle Decal; <br /> _D-estination Pability Alternate-Destinata ty -Transfer Facili : <br /> Daniels Sharpsmart Inc. Waste ManagementAAedical Waste Services <br /> 4144 ETherese Ave 7505 State Highway 65 7321 Quimby St <br /> Fresno CA 93725 Anahuac TX 77514 Incineration Signature&bate: Paramount,CA 90723 Transfer Signature&Date: _t <br /> Phone: 559-834-6252 Phone: 409-267-3913 Phone: 661-600-4368 <br /> Permit#: -- TS/OST-55,. Permit#: NSW2239-A Permit#: TS/OST-94 <br /> Waste Collected: UN 3291 Regulated Medical Waste n,o.s .2'PG 11 <br /> Shardsmart Containers Pharmaceutical " Regulated Medical Waste Trace Chemotherapy <br /> fi Tvpe Net Wt. Tvpe Net Wt. Type Net Wt. Tvpe Qty Net Wt. <br /> 514 S14PH 28 GAL <br /> X22 GAL <br /> 832PH 95;GAL` <br /> $32 :� SubTotai <br /> 514,x,+ S22PHA+ <br /> Total Containers <br /> 4+ S32PHA+ SubTotal <br /> Estimated Gross Lbs <br /> 2A' + S64PHA+ <br /> Pa$hONOM, ,gy (at.pickup): <br /> _ <br /> ;P,5_ <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 <br /> 28 GAL 7.00 or Discrepancies: <br /> Alternate Destination Facility <br /> Name: Curtis Bay Energy <br /> Address: 3200 Hawkins Point Road <br /> Na <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'cons'ignment are fully and accurately described above by proper shipping name and are classified, <br /> packed,marked,and labeled,and aro.in all aspects in proper condition for transport according to applicable government regulations. <br /> sctare thatfhts shipptYrt311t f wa�etsYree bf a p er ury wase as eine y e co e ot tecle a regu a i ns an or <br /> appropriate state rule's an°4reg <br /> "` <br /> u rorts <br /> Generator(Customer): ;R '` `y' <br /> y <br /> ame o ho rzed p r�on( r r � <br /> Route Driver: ` ' ' <br /> (If Applicable) Name of authorized person(print) Signature bate <br /> Transfer Driver: <br /> .`; Name of authorized person(printf Sigoafure Date <br /> Certification of receiptof waste as covered by this manifest number. <br /> tificate of Receipt: '$ <br /> me of authorized person(print) <br /> Signature pate <br /> ification of receipt,and destruction of waste as covered by this manifest number. <br /> Certificate of Destruction: pir <br /> Name of authorized person(print) Signature fate <br /> White Green Canary Pink Gold ' <br /> Certificate of Destruction-Return to Customer Daniels Destination Facility ,Transporter Custo„fner <br />