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Daniels Sharpsmart Inc. Tel: 559-834-6252 Manifest#: 713677 <br /> k 4144 E Therese Ave Fax:559-834-2242 Customer#: 10232 <br /> Fresno CA 93725 Old Location# <br /> DaFARIS For Chemical Emergency Date: Jun 14,2013 <br /> Spill,Leak,Fire,Exposure,or Accident Friday-606 <br /> Call CHEMTREC Day or Night 11111111111111111111111111111111-800-4249300 7 1 3 6 7 7 <br /> Generator: Carrier: Transporter Permits: <br /> State 1D 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 Sharpsmart Inc. Waste Management Medical Waste Services <br /> 4144 E Therese Ave 7605 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 /> i <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s 6.2 PG II <br /> Sharpsmart Containers Pharmaceutical Regulated Medical Waste Trace Chemotherapy <br /> Type Qtv Net Wt. Type Qty Net Wt. Type Qty Net Wt. Type Q_yt Net Wt. <br /> i <br /> S14 S14PH 28 GAL <br /> S22 S22PHGA <br /> #j <br /> S32 S32PH 96 GAL SubTotal <br /> S14A+ S22PHA+ <br /> Total Containers o <br /> 322A+ S32PHA+ SubTotal Lei <br /> Estimated Gross Lbs <br /> S32A+ S64PHA+ _ Pathology (at pickup): j <br /> S64A+ _ 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 /> Alternate Destination Facility <br /> I <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-WMI.0036 <br /> Generator Certification: :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 /> further declare that this shipment of waste ion s fre f hazardous and mercury waste as defined by the US code of feder regulatiand/or <br /> a ropnate state les regui tions. <br /> Generator(Customer): s (r+ l + <br /> e of authorized ue on( ign ture / Dat / 3 <br /> Route Driver: 197c' -G-.�• <br /> (If Applicable) am eof a ttivrized person(PtInt) Si ature Date <br /> Transfer Driver: ((J _ <br /> Name of authorized person(print) Signature Date i <br /> Ce if' tion of receipt of waste as c d by this manifest number. <br /> Certificate of Receipt: <br /> Name of authorized person(print) Signature Date <br /> Certification of recsiot and destruction aste as covered by this manifest number. <br /> Certificate of Destruction: <br /> Name of authorized person(print) Signature Date j <br /> White Green Can Pink Gold i <br /> Certificate of Destruction-Return to C:stomer Daniels Dustina.ior.Facility Transporter Customer <br />