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Certification Statement <br /> FOR NON-MEDICAL WASTE GENERATORS AND MEDICAL WASTE GENERATORS NOT REQUIRED TO REGISTER <br /> Business Name: Vienna Nursing and Rehabilitation Center <br /> Business Address: 800 South Ham Lane <br /> i <br /> Lodi CA 95242 <br /> City State Zip Code <br /> Phone Number: {209) 368-7141 <br /> Contact Person: Corey Wright Administrator <br /> I am not required to register as a Medical Waste Generator because: <br /> Please check the appropriate statetnent(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,incinerating or <br /> microwaving. <br /> ❑ Other: <br /> Please indicate the appropriate statements): <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 /> 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 /> Signature, Title: Date: <br /> i <br /> EHD 45-03 <br /> s ni�nnm � <br />