structions Initial Receip AS Date and Time El E 0 III HAZMAT Req. Charging Biohazard Other • M Latcnts Freeze 0 • FM Refrigerate Signeturc of S • Printed Name/ _ 8 b Y i ii choOtom Reason: Initial Collected By: Agency: Amfai Date and Thne Rellaqa • - Date and Time ; Signature Print