My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
COMPLIANCE INFO_2004-2020
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
Y
>
YOSEMITE
>
1777
>
4500 - Medical Waste Program
>
PR0450109
>
COMPLIANCE INFO_2004-2020
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
11/8/2024 3:08:48 PM
Creation date
7/3/2020 10:18:19 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4500 - Medical Waste Program
File Section
COMPLIANCE INFO
FileName_PostFix
2004-2020
RECORD_ID
PR0450109
PE
4522 - ACUTE CARE FACILITY
FACILITY_ID
FA0003978
FACILITY_NAME
KAISER FOUNDATION - MANTECA
STREET_NUMBER
1777
Direction
W
STREET_NAME
YOSEMITE
STREET_TYPE
AVE
City
MANTECA
Zip
95337
APN
20018034
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\cfield
Supplemental fields
FilePath
\MIGRATIONS\MW\MW_4522_PR0450109_1777 W YOSEMITE_.tif
Site Address
1777 W YOSEMITE AVE MANTECA 95337
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
195
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
SAN JOAQUIN COUNTY <br /> _ ? EN*ONMENTAL HEALTH DEPART <br /> y {� L EPyyAdENT <br /> 600 East Main Street, Stockton, CA 95202-3029 CEIYED <br /> Telephone:(209)468-3420 Fax: (209)468-3433 Web: www.sjgov.org/ehd JAN <br /> �crFaR?� 2011 <br /> ` � Q <br /> APPLICATION FOR A LIMITED QUANTITY HAULING EXEMPTION '4 F"J�A,0),U,rN,10,u, <br /> HF��rH CEPA TMgL <br /> �P <br /> To qualify for a"Limited Quantity Hauling Exemption"pursuant to the "Medical Waste Management Act", the following <br /> conditions must be met: <br /> The generator or health care professional generates less than 20 pounds of medical waste per week, transport less <br /> than 20 pounds of medical waste at any one time, maintains a tracking document pursuant to Chapter 6 and the <br /> generator or parent organization has on file one of the following: <br /> 1. Medical Waste Management Plan if the generator or parent organization is a large quantity generator <br /> or a small quantity generator required to register pursuant to Chapter 4. <br /> 2. Information Document if the generator or parent organization is a small quantity generator not required <br /> to register pursuant to Chapter 4. <br /> Please complete the information below and mail with $77.00 fee to: <br /> San Joaquin County Environmental Health Department <br /> Medical Waste Management Program <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Medical Waste Hauler Information <br /> ❑ New Renewal <br /> Medical Office/Business Name: Ve.(m a-nrw� (y\A.(4e-c& to U-`=-\k-a-' <br /> Medical Office/Business Address: -l�l \) . q o <br /> OWt-}e c a Cit(-, cis 3377 <br /> CityState Zip Code <br /> Contact Person: I;r-04+ rDD:aSS1 <br /> Phone Number: aim — 1259- 762) p <br /> Storage Facility Name: i Stw 'PefW\O n e.,yiti <br /> Storage Facility Address: Q. LApseenz <br /> "44ceN CIA S33-7 <br /> City State Zip Code <br /> Permitted Treatment Facility Name: <br /> Permitted Treatment Facility Address: 41 w;- <br /> City State Zip Code <br /> List all employee names and titles authorized to transport the medical waste (If more than 3, attach info): <br /> 1. Name:��C.p��o"rri S Title: Q�(- <br /> 2._Name:Imam alun__ Title: _ . <br /> 3. Name: Title: <br /> A copy of this exemption and a tracking document shall be in employee's possession at all times while transporting medical waste. In <br /> addition,all copies of medical wasteFtprds shall be kept on file atgenerator's or health care professional's facility. <br /> Applicant Signature; Date: 1'7,f-7/-1�l <br /> Title: ' <br /> DO NOT WRITE BELOW THIS LINE <br /> R.E.H.S. Application Approval: ^ Date:0j—/0 <br /> Expiration Date: �2/�/ Date Paid: �/ 3 / _ Check • d Q-Received By: (� <br /> EHD 45-01 <br />
The URL can be used to link to this page
Your browser does not support the video tag.