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Registration fo a to <br /> For Generators of Medical Waste <br /> GE TOIL NAME; �Piocb kwtmki <br /> f <br /> Generator Facility Address: 90 <br /> QC,A 'sa4 <br /> City State Zip Code <br /> Phone Number: (P 7/ */ <br /> Generator Mailing Address: e, at c- 1/ <br /> City State Zip Cade <br /> Type of Business: <br /> Authorized Representative: <br /> f <br /> Title: At <br /> Emergency Phone Number: L205 ) 369 -1114-1 <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 /> S s <br /> Signatur Title: Date` <br /> EM 45-03 <br /> 2015 <br />