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_ Daniels Sh art Inc. Tel: 559-834-6252 Manifest#: 714502 <br /> 4144 E Therese Ave Fax:559-834-2242 Customer#: 10232 <br /> Fresno CA 93725 Old Location# <br /> Daniels For Chemical Emergency Date: Jul 12,2013 <br /> utetii+a He.3111cc a sale- Spill,Leak,Fire, Exposure,or Accident Friday-606 <br /> Call CHEMTREC Day or Night <br /> 1-800.424.9300 7 1 4 5 0 2 <br /> Generator: Carrier: Transporter Permits: <br /> State ID No.: Daniels Sharpsmart, Inc. CA-4707 <br /> Deuei 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#: NSW 2239-A Permi #: TS/OST-94 � <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s 6.2 PG II <br /> Sharpsmart Containers Pharmaceutical Re ug_ lated Medical Waste Trace Chemotherapy <br /> Type City Net Wt. Type gty Net Wt. mpg Qty Net Wt. Type Qty Net Wt. <br /> S14 S14PH 28 GAL <br /> S22 _ _ S22PH 38 GAL <br /> S32 _ S32PH GAL V/ r SubTotal <br /> S14A+ S22PHA+ y, „2 <br /> -� ------ -� � Total Containers <br /> S22A+ S32PHA+ SubTotal <br /> Estimated Gross Lbs <br /> S32A+ S64PHA+ Pathology (at pickup): _ <br /> S64A+ SubTotalT <br /> otal NET Lbs. <br /> 49 <br /> SubTotal <br /> Transporter ID's Returned: (LG) (MEQ) (SM) -- <br /> Clean Products Delivered: -- <br /> Product: Ordered: Qty Delivered: I Notes Comments or Discrepancies. <br /> 28 GAL 7.00 <br /> 1 <br /> Alternate Destination Facility <br /> Name: Cur'is Say 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: 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 t t his shipment of waste is free hazardous and mercury waste as defined by the US code of federal regul tions and/or <br /> appropriate sty rul and r tions. <br /> Generator(Customer): -- <br /> Rahz!a of authorized pe on(grin Si at re /[] Date <br /> Route Driver: <br /> (If Applicable) of aut d perso (prin i nat e Date <br /> Transfer Driver: <br /> Name of authorized person(print) Signature Date <br /> C ific tion of receipt of was a vered by this manifes ber. <br /> Certificate of Receipt: <br /> Name o authorized person(print) Signature Date <br /> Certification of receipt and d tion of waste as covered by this manifest num <br /> Certificate of Destruction: — <br /> Name of authorized person(print) Signature Date <br /> White Green Canary. _ Pink Gold <br />