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?ter r 7C <br /> 4 M LL N. g N V �6+ <br /> po W v : <br /> to <br /> F'gg =.�' <br /> ." x <br /> <.., ... .. . ., . s� <br /> k .s ` kU '''-' yx'.- <br /> rs <br /> _u <br /> moo <br /> s <br /> Owl ��Iat t o$S x Fr >: a s <br /> �..MEMO <br /> „` `,^'`,fir;,. �.^„ <br /> a <br /> �r <br /> it <br /> ac <br /> B.,t,tIadICa18S8i�! zfi�^ s <br /> `,., s x „ ` a "ks x.d w^ <br /> t ftpattr�� ,> <br /> w } ' a s <br /> 07 <br /> vF <br /> k <br /> is <br /> a <br /> r <br /> It, "Y <br /> y �y, <br /> r <br /> .,.i r,,,:, xm.mss, a ."•:rofiw„ <br /> ;� 1 <�1V1 � i7» C3 Gla tTAANS t�cpt of medlt waste aS d@SCr�be4i�bdVs � �, <br /> a r� ` ax-zywr �. „zf '`>�. ^z' �^+* "." -'•" "xa rz*ra;xi�.. ^^ 's= � ,� "�x'�x � '" " <br /> �, �tinllA'�pe IN e` ' 5rgna�t�f$, Date <br /> 7H A CRE tt�tDt tt F <br /> fi QM t pj ......w4..t`4�TM�'ay YY i"Rl <br /> Fa X11 fst� clltty <br /> jivew <br /> kn> r'>n s <br /> Ttl,, s^ <br /> I 3 s <br /> TREATMENT 1 AdiuTY I certify±that 1 have be4n authoriiecl by the appiic ble'state`agen6y to accept untreate"d°Medidai wa�st�s that 1 ti��re <br /> rece►vea the above md�cated wastes�n acdor�{ance With the requ"iremeiitou tined in that;authorization. <br /> PnritTrpd"fJatne - Signature Date :. z< <br /> t 4rsFt ' t tc .°'?D �`` ## <br /> r , <br /> LtAVE AT <br />