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b: Daniels Sh mart Inc. Tel: 559-834-6252 Manifest#: 714684 <br /> 4144 E Therese Ave Fax:559-834-2242 Customer#: 10232 <br /> ®alniel� Fresno CA 93725 Old Location# <br /> For Chemical Emergency Date: Jul 19,2013 <br /> Ai3k,i-�H«31rw�k•9 snit- Spill, Leak,Fire,Exposure,or Accident Friday-606 <br /> Call CHEMTREC Day or Night 111111111111111111111II��IAUryryIII�IIpp� � ��IUIII�� <br /> 1-800-424-9300 7 1 4 6 8 4 <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 M TS/OST-55 Permit#: 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 Mecrical Waste Trace Chemotherapy <br /> Type City Net Wt. Type City Net Wt. Type Qty Net Wt. Type City Net Wt. <br /> S14 S14PH 28 GAL <br /> S22 _ S22PH 38 GAL _ <br /> S32 _ S32PH AL SubTotal <br /> S14A+ _ S22PHA+ <br /> Total Containers <br /> S22A+ S32PHA+ SubTotal -� <br /> Estimated Gross Lbs <br /> S32A+ e _ 564PHA+ Pathology (at pickup): <br /> S64A+ SubTotal <br /> Total NET Lbs. <br /> SubTotal <br /> Transporter ID's Returned: (LG) (MED) (SM) <br /> Clean Products Delivered: <br /> Product: Ordered: Delivered: <br /> Notes or Discrepancies: <br /> 28 GAL 7.00 <br /> Alternate Destination Facility <br /> Name: Curtis Bay Energy <br /> Address: 3200 Hawkins Point Road <br /> City/State/Zip: Baltimore,MD 21226 <br /> Phone: 443-692-2300 <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 declart is shipment of waste is free of hazardous and mercury waste as defined by the US c eder regulations a dlor <br /> apgrapria '9� <br /> te st t le d regulations. J <br /> Generator(Customer): _ �/ <br /> a &ofthoriz ( DateRoute Driver:T Applicable} z rson(print) _ na re Date l <br /> Transfer Driver: <br /> Name of authorized person(print) Signature Date <br /> Ce <br /> ' 'on of recreipt of was covered by this manifest ber. <br /> mCertificate of Receipt: <br /> arae of authorized pers rant) Signatur�emanifest <br /> �'� Date <br /> Certification of receipt and <br /> as uction of waste as covered by this ma st num r. <br /> Certificate of Destruction: _ <br /> Name of authorized person(print) Signature Date <br /> White _ _ _ Green CanaryPink Gold <br />