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Manifest 713074 <br /> Danieis Sharpsmart Inc. Tel: 559-834-6252 #: <br /> r 4144 E Therese Ave Fax:559.834-2242 Customer#: 10232 <br /> Fresno CA 93725 Old Location# <br /> For Chemical Emergency Date: May 24,2013 <br /> Spill,Leak,Fire,Exposure,or Accident Friday-606 <br /> Call CHEMTREC Day or Night IIIIfII�tUII�IIII�II�I�li�lp��ll <br /> 1-800-424-2300 ti u Wt <br /> 7 1 3 0 7 4 <br /> Generator: W�� �W � Garnier: 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 Snarpsmart Inc. Waste Management Medical Waste Services <br /> 4144 E Therese Ave 7505 State Highway 65 7321 Quimby St <br /> Fresno CA 9725 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#: TSIOST-55 Permit#: NSW2239-A Permit#: TSIOST-94 <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s 6.2 PG-T—'— <br /> Sharpsmart Containers Pharmaceutical Regulated Medicl Waste Trace Chemotherapv <br /> Tvpe Qty Net Wt. Type <br /> Qty Net Wt, Tvae Pty Net Wt. Type Qty Net Wt. <br /> S14 _ S14PH 40 <br /> 28 GAL <br /> -91 <br /> S22 �.__ w._ . a✓ ' GAL <br /> S32 �a. S32PH _a_ -� 96 GAL SubTotal _ _ - <br /> S14A+ S22PHA+ <br /> Total Containers <br /> '22A+ S32PHA+ SubTotal ✓ [I►! <br /> Estimated Gross Lbs <br /> S32A+ __ ..� S64PHA+ - _ Pathology (at pickup)' <br /> s <br /> S64 ._ biotaOCZ Total NET Lbs. <br /> SabTotal _ <br /> Transporter ID's Returned: (LG) _r (MED) (SM) <br /> Clean Products Delivered: <br /> Product: Ordered: Qtv Delivered: '-- ---`-------•--'---- --___I <br /> 28 GAL 7.00 Notes Comments or Dispancies: <br /> i .� on <br /> t �� <br /> � � l X13 <br /> I Alternate Destination Facility <br /> f <br /> I Name: Curtis Bay Energy <br /> •.Address: 3200 Hawkins Point Road <br /> City/State/Zip: Baltimore,MD 2126 <br /> (Phone: (410 354-3228 ? I <br /> L'Permit#: 200 W MI-0036 es <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 further aeclare that this shipment of waste is free of hazardous an mercury waste as defined b the US code of fel regulations and/or <br /> — ppraprtatestate rules d7egutati <br /> Generator(Customer): _ _ Ilk— <br /> Name of authors d person(print): Signa Date <br /> Route Driver: <br /> (If Applicable) a31hakthI �(p S nat r Date <br /> Transfer Driver: <br /> Name of authorized person(print) Signature Date <br /> fi tion of receipt of to as code,ed by this manife <br /> Certificate of Receipt: % �' <br /> Name of authorized person(print) Signature Date <br /> Cgrtification of receipt and destruction of rte,as covered by this manifest number. . <br /> Certificate of Destruction: �� <br /> 13 <br /> Name of authorized person(print) Signature Date <br /> White Green Canary Pink Gold <br /> Cartifr„ate of Destruction-Return to Customer Daniels Destination Facility Transporter Cvstome, <br />