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Registration for Medical Waste <br /> For Generators of Medical Waste <br /> GENERATOR NAME: California Health Care Facility <br /> Generator Facility Address: 7707 South Austin Road <br /> Stockton, CA 95215 <br /> Phone Number: ( oq 1 City q U-7_ H lV^73 State Zip Code <br /> � <br /> Generator Mailing Address: 7707 South Austin Road <br /> Stockton, CA 95215 <br /> City State Zip Code <br /> Type of Business: Correctional Facility <br /> Authorized Representative: Kimberly Spurlin <br /> Title: Correctional Health Services Administrator II <br /> Emergency Phone Number: 46-7- q LDr73 <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: Title: Date: 6�51 <br /> EHD 45-03 4 <br /> 2015 <br />