Laserfiche WebLink
Registration Medical Waste <br /> For Generators of Medical Waste <br /> GENERATOR NAME: SUTTER TRACY COMMUNITY HOSPITAL <br /> Generator Facility Address: 1420 North Tracy Boulevard <br /> Tracy CA 95376 <br /> City State Zip Code <br /> Phone Number: (209) 835. 1500 <br /> Generator Mailing Address: 1420 North Tracy Boulevard <br /> Tracy CA 95376 <br /> City State Zip Code <br /> Type of Business: Acute Care Hospital <br /> Authorized Representative: Bernard J Bourque, HEM <br /> Title: Safety Officer, Emergency Management and HazMat Coordinator <br /> Emergency Phone Number: (209) 596. 2802 <br /> REGISTRATION FOR: <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 /> Signature: a Title: Safety Officer Date: 01/20/2016 <br /> EM/HazMat <br /> EHD 45-03 4 <br /> 2015 <br />