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Registration for Medical Waste <br />For Generators of Medical Waste <br />GENERATOR NAME: Lz�k Duflg,'c_c Ce(1%er� <br />Generator Facility Address: c5. Ham Lr1 k <br />Lu& CfN <br />City State Zip Code <br />Phone Number: ( ) (pq 0 <br />Generator Mailing Address: <br />City State Zip Code <br />Type of Business: r�l��l�c_c�i ScsCCA I c A Cej1 cr <br />Authorized Representative: c� i ►'i l�� 1'l lam' <br />Title: f -pr <br />Emergency Phone Number: ( 2-001) ���J�J 0 C CS <br />❑ Small Quantity Generator with Onsite Treatment (Generates less than 200 lbs/month). <br />Large Quantity Generator Only (Generates 200 lbs or more/month). <br />❑ Large Quantity Generator with Onsite Treatment (Generates 200 lbs or more/month). <br />I declare under penalty of law that to the best of my knowledge and belief the statements made herein <br />are correct and true. I hereby consent to all necessary inspections made pursuant to the California <br />Medical Waste Management Act and incidental to the issuance of this registration and the operation <br />of this business. <br />EHD 45-03 4 <br />2015 <br />