Laserfiche WebLink
REGISTRATION FOR [E <br />r • • <br />GENERATOR <br />City State Zig <br />Phone Number ) <br />Es <br />TYPE OF BUSINESS: <br />AUTHORIZEDREPRESENTATIVE: <br />TI <br />EMERGENCY PHONE NUMBER: ( <br />REGISTRATION FOR: <br />(Check One) <br />Small Quantity GeneratorOnsite Treatment.(Generates 00 r <br />Large Quantity GeneratorOnsite Treatment.•i or • • • <br />I declare under penalty of law that to the best of my knowledge and belief the statements <br />made herein •true. I hereby• • inspections• <br />pursuant to the California Medical Waste Management Act and incidental to the issuance <br />of this registration and the operation of this business. <br />SIGNATURE: : <br />v <br />