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• Stencycw <br />IN CASE OF EMERGENCY CONTACT: CHEMTREC 1-BDO-424.9300 aiAnunhu MAnirr oI wrue•z,•NU. m <br />705-12 CUSTOMER NO, 21132 NIDTIC0001-3P2 <br />PrInMpe Name Signature <br />nnrn__wer <br />Date <br />1. Generator's Name, Address and Telephone Number <br />Ai ?Ia. LI'l-gill Bat1t1illil9Jl <br />t <br />n � � t � <br />r �� t•�t,�i <br />R1;MI`/S'G`jiF NlEDICAL PLAZA 1J,thIit <br />t•= i• <br />2505 W i IANlWIER LH <br />,12/'0/2(l21 <br />``aTOC',' l FI, CA 95209-2u"'Ir � c <br />(:_0J) 521-6097 <br />6131,"f60-150 <br />CUSTOMER NUMBER GENERATOR'S REOIB"AnoN N <br />2A, DESCRIPTION OF WASTE <br />2B, CONTAINER TYPE <br />20. NO. OF <br />2D. VOLUME <br />UN3291 Regulated Medical Waste, n.o.s„ <br />�_ , r r.. ., , <br />I; <br />