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FOR NON -IN WASTE GENERATORS AND MEDICAL WASTE GENERATORS NOT REQUIRED TO REGISTER <br />Business Name: YI Y,1 trim 1T M—My 1U, <br />Business Address: LA QUA <br />cV,- q n CA <br />City State Zip Code <br />Phone Number: <br />Contact Person: <br />I am not required to register as a Medical Waste Generator because: <br />Please check the appropriate statement(s) <br />n I do not generate any medical waste. <br />n 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, incinerating or <br />microwaving. <br />Other: MC2 <br />J <br />❑ I declare under penalty of law that to the best of my knowledge and belief, I do not generate or <br />store any of the wastes specified on the "Pre -Application Questionnaire" as regulated medical <br />wastes in an amount that equals or exceeds 200 pounds per month. <br />Signature: <br />FHD 45-03 <br />1016/2003 <br />I declare under penalty of law that I will not be treating any amount of regulated medical wastes <br />at my facility by way of autoclaving, incinerating or microwaving. <br />91 <br />