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Daniels cl art Inc. Tel: 559-834-6252 If Manifest#: 714407 <br /> 4 4144 E Therese Ave Fax:559-834-2242 Customer#: 10232 <br /> Fresno CA 93725 Old Location# <br /> Daniels For Chemical Emergency Date: Jul 05,2013 <br /> i.t9ti�,a teatt�rs a SAA Spill, Leak,Fire,Exposure,or Accident Friday-606 <br /> Call CHEMTREC Day or Night Illlullllaq�lll�llllllf �� <br /> 1-800-424.9300 7 1 4 4 0 7 <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: Alternate Destination Facility 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 M NSW2239-A Permit#: TS/OST-94 <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 Oty Net Wt. Type Qyt Net Wt. Type f?yt Net Wt. Type Q_yt Net Wt. <br /> S14 -�� —Z' 4V 28 GAL - <br /> S22 b H ? -t--i 38 GAL <br /> S32 S32PH LiGAL SubTotal <br /> S14A+ S22PHA+ <br /> Total Containers <br /> S22A+ S32PHA+ SubTotal <br /> Estimated Gross Lbs <br /> S32A+ S64PHA+ Pathology (at pickup); <br /> S64A+ _ SubTotal <br /> Tota!NET Lbs. <br /> SubTotal <br /> Transporter ID's Returned: (LG) (MED) (SM) <br /> Clean Products Delivered: T <br /> Product: Ordered: Qty Delivered: 1rNotes Cmments or Discrepancies: <br /> 28 GAL 7.00 <br /> Alternate Dest atiorl Faciftfy <br /> Name: Curtis Bay Energy <br /> Address: 3200 Hawkins Point Road <br /> City/State/Zip: Baltimore,MD 21226 <br /> Phone: (410)354-3228 ^ i <br /> i Permit#: 2005-W MI-0036 1 o! <br /> Generator Certification: 1 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 furthef declare that this shipment of waste is free of hazardous a m waste defined the US code c7f fed ral regulations and/or <br /> appro _ e ate rules a d regulati ns. X O(({ 9 --T it r <br /> Generator(Customer): C, _ <br /> Name of authorized pe (Ant): Signature ! Dat <br /> Route Driver: <br /> (If Applicable) a e o uth i Ina a Date <br /> Transfer Driver: <br /> Name of authorized person(print) Signature Date <br /> ertifi !on of receipt of was covered by this manifest nu <br /> Certificate of Receipt: <br /> Name of authorized person(print) ` Signature Date <br /> Certification of receipt and destruction of waste as covered by this manifPnu er. <br /> Certificate of Destruction: Z/`7 �/ C <br /> Name of authorized person(print) Signature Date <br /> White Green Can Pink Gold <br />