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Daniels Sh art Inc. Tel: 559-834-6252 Manifest#: 715022 <br /> 4144 E Therese Ave Fax:559-834-2242 Customer#: 10232 <br /> i' Fresno CA 93725 Old Location# <br /> caniuls For Chemical Emergency Date: Aug 02, 2013 <br /> r A03 aealINCeve s0c- Spill,Leak,Fire,Exposure,or Accident Friday-606iII( III <br /> Call CHEMTREC Day or Night 11111l11uglIIINII1R111f 11III <br /> 1.800-424-9300 7 1 5 0 2 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: 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#: NSW2239-A Pgrmit#: TS/OST-94 <br /> Waste Collected: UN 3291 Regulated Medical Waste n.o.s 6.2 PG 11 <br /> Sharpsmart Containers Pharmaceutical Regulated Medical Waste Trace Chemotherapy <br /> Type QtY Net Wt. Type (City Net Wt. T��e 0yt Net Wt. Type Pty Net Wt. <br /> S14 S14PH 28 GAL <br /> S22 S22PH 38 GAL <br /> S32 S32PH AL 2/ SubTotal <br /> S14A+ S22PHA+ 3 <br /> -- ----- Total Containers <br /> S22A+ — ®__- S32PHA+ _ SubTotal Estimated Gross Lbs <br /> S32A+ S64PHA+ Patholosty (at pickup): <br /> S64A+ SubTotal — f n2 <br /> Total NET Lbs. <br /> SubTotal <br /> Transporter ID's Returned: (LG) (MED) (SM) <br /> Clean Products Delivered: -- <br /> Product: Ordered: Qtv 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/State/Zip: Baltimore,MD 21226 <br /> Phone,443-692-2300 <br /> L� t#: 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 t s s ipment of waste is free of hazardous and mercury waste as defined by the US code o de i regulatii ns and/or <br /> appropriate state s an r ula' ns. (/"" � //1220 <br /> Generator(Customer): _M <br /> a o authorized pelff( int}: - ignat re <br /> Route Driver: fftt <br /> (if Applicable) a e of auth z on(print) S at e Date <br /> Transfer Driver: — <br /> Name of authori%zed person(print) Signature ate <br /> Certification of receipt of waste vered by this manifest num <br /> Certificate of Receipt: <br /> Nim;of authorized person(poN Signature to <br /> Certificat' n of recei `and destr ctio of ante as covered byjWsMnifest number. <br /> Certificate of Destruction: <br /> Name of authorized person(print) Signature <br /> White Green Canary _ Pink Gold <br />