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� •����,��`�"%,���K`-s`'Es.Ff cr �F�$ aS�FJI.,FAH .NU�V-F,�AZARDOUS,�QSTSS. ONI,X: NO;:����o �- <br /> 2+, ti <br /> { <br /> �vp{ r fLr f Vii"-. r r •� �2� <br /> .1�% •1 ,GI 7`�iG -WASTE' TO -Eg:.DISPOSED <br /> Des ript o f Waste ..... <br /> `z 4, <br /> Wear::gloves,; gog$]es'..and protective;.�C'lothiAg. <br /> Y Qi/9 ;, <br /> This is to.-certifythat the- above 'go4wd.:.'' <br /> �► ,l4Cpicia ;s1 are pro fi <br /> :c .aseed <br /> 7 Sig tura of.: tt�or a AgenC ♦ Da[e <br /> ? Os�4TC(?RORQTED J'QB. N0. 5 UN T :NO D <br /> t <br /> . �.. <br /> �' 4T5-Ar;Ta&as `Avenin Pick�Up ;Date f/` 7- 9/ Time <br /> ,` ;— <br /> �}� �4$±� ].�4 at '' ;_ �]OT�; Thi.�a' form..is x4 �a.�used :in ;'lieu-ohe. <br /> Y Cel,if'oruis, Department 46U Health Services <br /> 8asardods;Wast,a::}1aRifeec for N4NtSA &DOUS <br /> gr3�xtidrxA9�at WASTES :only• <br /> } -f1w.. M7r, S afw- Jy 1 ,ti <br /> 7. ! 4 <br /> Qty, ; CBivea: i3b1a GaY Cu/Yd 1OK1r.. <br /> p. <br /> .__,. . <br /> 01SPOSAa,"MMOD <br /> ;,: tlrface°YmpouuctmenC.: Signature: of Authorize4 Agoot (Date)' <br /> RETURN..'COU, T0: <br /> STAMC0INC. <br /> P..o. BOX15U <br /> BAN MARTIN. CA• t0t>046 <br />