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......... ..-__._. ____._ •__..._... _......... .. - _....... ._..__.._. __..._._._......... _..___... <br /> I t .....I ;'... .. ... <br /> I <br /> Registration for Medical Waste I <br /> For Generators of Medical Waste <br /> i <br /> GENERATOR.NAME: Riverwood Healthcare Center <br /> I ' <br /> Generator Facility Address: 5320 Carrington Circle <br /> Stockton CA 95210 <br /> City state Zip Code <br /> Phone Number: t 209 ) 473-3004 <br /> Generator Failing Address: Same as above r^_ <br /> City State Zip Code <br /> Type of Business: Skilled Nursing Facility <br /> Authorized Representative: Reginald Goring <br /> Title: Administrator <br /> Emergency Phone Number: ( 209 ) 473-3004 <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 <br /> I declare under penalty of lave 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 /> r <br /> Signature: Title: Administrator Date: oxw18 <br /> i •: <br /> EHD 45-03 4 <br /> 2015 <br />