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— -- <br /> 9116, <br /> w Daniels Sharpsmart Inc. Tel: 559-834-6252 Manifest#: 713542 <br /> 4144 E Therese Ave Fax:559-834-2242 Customer#: 10232 <br /> Fresno CA 93725 old Location# <br /> Daniels Fresno <br /> Chemical Emergency Date: Jun 07,2013 <br /> taaki .,can"c.r a s::+e Spill,Leak,Fire,Exposure,or Accident Friday-606 <br /> Call CHEMTREC Day or Night 11lI�Illl�llllll�llllQlllllllffll <br /> 1-800-424-9300 7 1 3 ,5 4 2 <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: r Alternate Destination Facility Transfer Facility: <br /> Daniels Sharpsmart Inc. Waste Management Medical Waste Services <br /> 4144 E Therese Ave 7505 State Highwzy 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: 661-600-4366 <br /> Permit#: TS/OST-55 Permit#: NSW2239-A Prm)_ TSIOST-94 <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s .2 PG II <br /> Sharpsmart Containers Pharmaceutical Regulated Medical Waste Trace Chemotherapy <br /> Type Qty Net Wt. Type Oty Net Wt. Type _Qty Net Wt. Type Qtv Net Wt. <br /> S14 _ S14PH _ 28 GAL <br /> S22 M— S22PH �- 0AL <br /> S32 — _ S32PH tc'Al- SubTotal _•� _ _ ___ <br /> S14A+ S22PHA+ <br /> ---- --"-- - '• "' Total Containers <br /> '22A+ S32PHA+ SubTotal <br /> Estimated Gross Lbs <br /> S32A+ S64PHA+ r_ _.. Pathology (at pickup): <br /> S64A+ _ �_ W SubTotal <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 or Discrepancies: <br /> 28 GAL 7.00 <br /> i <br /> I <br /> Alternate Destination Facility <br /> Name: Curtis Bay Energy <br /> Address: 3200 Hawkins Point Road <br /> City/Slate/Zip: Baltimore,MD 21226 <br /> Phone: (410)354-3228 <br /> i Permit#: 2005-WMI-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 all aspects in proper condition for transport according to applicable government regulations. <br /> I further declare that this shipment of waste is free of hazardous and mercury wast as defined by the US code of federal r guiations and/or <br /> app priate state rut re ons. —��� <br /> Generator(Customer): � `!^�(j q _ _ —_ <br /> f a!th^rizest�r on(p Si nature Date 1/ <br /> Route Driver: [/� �j <br /> (If Applicable) 01,W%person(print) igurs DateTransfer Driver: <br /> fName of authorized parson(print) _ A ignature Date <br /> :32�z <br /> iceipt of waste as coy y this manifest number. <br /> Certificate of Receipt: 0 '^ <br /> ir.__ <br /> Name of authorized person(print) Signature Date <br /> Carti cation of receipt and destruction^of wast pvered by this manifest number. <br /> 6, -43 —0 <br /> Certificate of Destruction: I <br /> Name of authorized person(print) Signature Date <br /> White Green Canary Pink Gold <br /> Certificate of Destrucbcn-P,etum to Customer Danie s D-ast,nalton F3ciiity Trarspe<.ar Cusromar <br />