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<br />d5Lij 1 MCA' "'1=V'lr-A,'LH Y: i cerilly Tnat I nave Deen autnorizea Dy tne applicable state agency to accept untreated medical wastes and that I have
<br />15, received the above indicated wastes in accordance with the requirement outlined in that authorization.
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<br />Date
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<br />2B. CONTAINER TYPE
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<br />2D. VOLUME
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<br />3. Generator's Certification: "I hereby declare that the contents of this consignment are fully and accurately TOTALS 10-
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<br />7. DISCREPANCY INDICATION
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<br />d5Lij 1 MCA' "'1=V'lr-A,'LH Y: i cerilly Tnat I nave Deen autnorizea Dy tne applicable state agency to accept untreated medical wastes and that I have
<br />15, received the above indicated wastes in accordance with the requirement outlined in that authorization.
<br />Print/Type Name Signature
<br />LEAVE AT GENERATOR
<br />Date
<br />
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