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RECEIVED <br /> T 2 3 1991 <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> CERTIFICATION STATEAdENT <br /> FOR NON-MIEDICAL WASTEATO I , GENERATORS <br /> NOT REQUIRED TO REGISTE <br /> (Please Type or Print) <br /> BUSINESS E: Carrington Convalescent Hospital <br /> BUSINESS S: <br /> Street 532Q Carrington Circle <br /> City Stockton State CA Zip 95210 <br /> PHONE NUMBER: 0209 ) 473-3004 <br /> NAME OF RESPONSIBLE PERSON: Steve H. Marcus <br /> I Am Not Required. To Register As A Medical Waste Generator <br /> (Please check the appropriate statement(s).) <br /> I do not generate any medical waste. <br /> x 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, <br /> incinerating or microwaving. <br /> Other <br /> Please indicate The Appropriate Statement(s): <br /> (x) I declare under penalty of law that to the best of my knowledge and belief, I do not <br /> generate or store any of the wastes specified on the Vre-Application do " <br /> as "Regulated Medical " in an amount over 200 pounds per month. <br /> I declare under penalty of law that I will not be treating y amount of"Regulated <br /> Medical Wastes"at my facility byway of autoclaving, incinerating, or microwaving. <br /> SIGNATURE: ( : Administrator AT :10-15-91 <br />