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fA <br /> Daniels Sh mart inc Tel: 559 834-6252 Manifest#: 713204 <br /> 4144 E The a Ave Fax:559-834-2242 ' Customer#c 10232 <br /> Fresno CA 93725 Old Location# <br /> For Chemical Emergency Date May 31 2013 <br /> rawneugset �. I(I II606S Fnidayill,Lei Ex osure,or Accident <br /> Ca4CHEMC <br /> ff II ii <br /> Day or Night �"IIIIIIIII�II�I�II�IIIIII�IIIII�fI�'I <br /> 1-800-424-9300 <br /> Generator: Carrier: Transporter Permits: <br /> State ID No.: Daniels Sharpsmart, Inc. CA 4707 <br /> Reuel Vocational Institution 111 W Jackson Blvd EPA#CAL000344393 <br /> 23500 Kasson Rd Suite 720 <br /> Tracy, CA 95304 Chicago,yL. 60604 US DOT#1295076 <br /> Attn: ;; 312-546--8900 <br /> (_) - Vehicle Decal: <br /> Destination Fa, ihty: Alternate DestinatrorrFacility --- 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 93725 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 Permit#: TS/OST-94 <br /> Waste Collted. UN 32,91-Regulated Medical Waste n.o.s. .2 PG;N, <br /> Sharpsmart Zontainers !PharmaceuticalRegulated Medical Waste Trace Chemotherapy <br /> Type t Type Qty Net Wt Typer Net uVt. Type Net Wt. <br /> K <br /> S144sr S14PH 28 GAL t <br /> .S22 S22PH 38 GAL <br /> 7d` 00 <br /> "S32 ° �32PHb .,`M 96 GAL SubTotal <br /> S,a`4A+ y '8UPHA+ ' <br /> ,Y d" Total Containers <br /> + S32PHA+ 5ub7otal <br /> Estimated Gross Lbs <br /> Sb4PHA+ pathology <br /> (at pickup): <br /> —s64A+ guti T ala _ .. <br /> Total NET Lbs. <br /> SubTotal <br /> Transporter ID's Returned (LG) A 1Q, s (MED) (SM) <br /> Clean Products Delivere <br /> �P:roduct: Ordered: Qty Delivered: Notes Comments or Discrepancies: <br /> 2'S GAL 7.00 <br /> r <br /> Alternate Destination Facility <br /> Name: Curtis`Bay Energy <br /> Address: 3200 Hawkins Point Road <br /> City/State/Zip: Baltimore,MD '21226 <br /> p ; Phone: (410)354-3228 <br /> Permit#: 2005-WMI-0036_ , <br /> Generator Certifications thereby declare that the content of this consignment are fully and accurately described above byproper 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 /> her declare t i el7egutatorTs-and/or- <br /> approariate state rules and,r gulati <br /> Generator(Customer): 4116 <br /> Name of authorized person(print): Signature Date <br /> Route Driver: - i ^ <br /> (If Applicable) 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 /> `ificate of Receipt: <br /> Name of authorized person(print), Signature Date <br /> "Certification of receipt and destruction of waste as covered by this manifest number. <br /> Certificate of Destruction: <br /> Name of authorized person(prin#); .` Signature Date, <br /> Vlihrfe Green Canary Pink Gold <br /> G'eriifr`cate of Destruction-Return to Customer Daniels Destination Facility Transporter Customer <br />