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Daniels Slasmart Inc. Tel: 559-834-6252 Manifest#: 715362 <br /> 4144 E Therese Ave Fax:559-834-2242 Customer#: 604 7 <br /> _ Frn,^- Old Location# CA00002000-007 <br /> ` For Chemical Emergency Date: Aug 09, 2013 <br /> Date: Spill, Leak, Fire, Exposure,or Accident Friday-606 <br /> (001023-000002) <br /> Carrier: CA"4707 Call CHEMTREC Day or Night IIIIIIIII�'IIIII��II��IIII�IIII'll'II�II <br /> Generator: <br /> Daniels Sharpsmart Inc. 1-800-424-9300 <br /> en,el Vocational Institution 4144 E Therese Ave 7 1 5 3 6 2 <br /> 23500 Kass <br /> Rd Fresno CA 93725 Carrier: Transporter Permits: <br /> Tracy, CA 95304 559-634-6252 Daniels Sharpsmart, Inc. CA-4707 <br /> 111 W Jackson Blvd EPA#CAL000344393 <br /> RMW B►o-Autoclave Suite 720 <br /> Chicago, IL 60604 US DOT#1295076 <br /> 1 11M . 312-546-8900 <br /> ' Vehicle Decal: <br /> _ 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 Permit#: TS/OST-94 <br /> Waste Collected: LIN 3291 Regulated Medical Waste n.o.s 6.2 PG II <br /> Sharpsmart Containers Pharmaceutical Regulated Medical Waste Trace Chemotherapy <br /> Type Qty Net Wt. Type Qty Net Wt. Type Qlt rr Net Wt. Type Qty Net Wt. <br /> S14 S14PH 28 GAL <br /> S22 S22PH 38 GAL <br /> S32 ffi S6� S32PH 96 GAL SubTotal <br /> S14A+ A19® S22PHA+ <br /> Total Containers <br /> 'A+ _ ass S32PHA+ SubTotal <br /> Estimated Gross Lbs <br /> S32A+ S64PHA+ 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: Qty Delivered: Notes Comments or Discrepancies: <br /> S22 PH 2.00 <br /> S14 PH 4.00 <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 /> 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 that this shipment of waste is free of hazardous and mercury waste as defined by the US code of feral reuoulations nd/or <br /> appropriate state rules and regulations. <br /> Generator(Customer): <br /> Name of authorized person(print): Signature Date <br /> Route Driver: <br /> (If Applicable) " Name of authorized person"(print) Signature Date <br /> Transfer Driver: <br /> Name of authorized person(print) Signature Date <br /> Certification of receipt of waste as covered by this manifest number. <br /> tificate of Receipt: <br /> Name of authorized person(print) Signature Date <br /> Certification of receipt and destruction of waste as covered by this manifest number. <br /> Certificate of Destruction: <br /> Name of authorized person(print) Signature Date <br /> White Green Canary Pink Gold <br /> r...a:A...-,:..s n..........a,,., o..........,l`............ n....:..., n,...e:...,a,...C..,.:c.., r..........,s... ,.L....... <br />