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.. ., .. J. 'Z JJ�u:.wJ <br />Tarag Document <br />41 a tkt <br />iH 0-411, <br />i •� <br />®G 1211OWN <br />PAGE 19/25 <br />usto mer!UrtlMTWL'bWerti�y that the above named regulat medical waste is properly classified, describe , pack ged, marked and labeled, and <br />in proper conditi tion according to the applicable r 2M�� ./xprint ]Name �— ' � Customer Signature Date tj <br />tlifornia Medical Disposal, Inc. <br />00 E Therese Ave. . <br />ers # 6l <br /># ST32 <br />x x <br />id Signature Date Authorized Signature Date <br />y7 California Medical Disposal, Inc. <br />( 4100 E Therese Ave. <br />Fresno, CA 93725 <br />(559}834-5850 <br />Reg. Haulers # 4461 <br />Futhorized <br />IT # TS/0 <br />x x <br />Si to Date Authorized Signature. Date <br />California Medical Disposal, Inc. <br />4100 E Therese Ave. <br />Fresno, CA 93725 <br />(559)-834-5850 <br />Reg. Haulers # 4461 <br />PERMIT # TS/OST32 <br />x X <br />California Medlcat Disposal, Inc. <br />4100 Therese Ave. <br />Fresno, CA 93725 <br />(559)-834-5850 <br />Reg. Haulers 4 4461 <br />PERMIT # TSIOST32 <br />Authorized Signature Date Recd <br />Authorized Signature Date Authorized Signature Date Rec'd <br />UN3291, PG IL 6.2 <br />