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CERTIFICATION STATFAIENT <br />FOR NON-MEDICAL WASTE GENERATORS AND MEDICAL WAST1-: GENERATO <br />NOT REQUIRED TO REGISTER <br />(Please Type or Print) <br />BUSINESS NAME: <br />city State Zip <br />NAME OF RESPONSIBLE PERSON: <br />I Am Not ReqWzed To Register As A Medical Waste Generator Because: <br />[Please check the appropriate statement(s).] <br />I do not generate any medical waste. <br />I generate less than 200 pounds of medical waste per month. <br />I do not treat any medical waste at my facility by means of autoclaving, <br />incinerating or microwaving. <br />Other <br />Please Indicate The Appropriate Staternent(s): <br />I declare under penalty of law that to the best of my knowledge and belief, I do not <br />generate or store any of the wastes specified on the 'TApplication Questionnaire!' <br />as "Regulated Medical Wastes" in an amount over 200 pounds per month. <br />SIGNATURE: T=: DATE: <br />0 <br />