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May,13. 2011 9;OOAM San Joaquin County No -1896 P. 2/9 <br />EN''V IRWMENTAL HEALT EPARTMENT <br />�44�ty SAN JO!AQUIN COUNTY <br />c XJ'rrtY St�pery�sors <br />bonnA Y�, Hor8n,12.�.�3'.S. <br />:- 600 East Main Street Carl Borgman, RE ES. <br />Director <br />Laurie A. Cotulla, RXILS. Stockton, California 45202 Mike Huggins, R.E.H.S., R.D.I.Margaret I.agorio, R.EB.S. <br />e'. ;'• Assistant Director Telephone: (209) 468-3420 Robert McClellon, R.E.H.S. <br />Fax: (20�) 468-3433 <br />Jeff Carruesco, R.E.H.S. <br />Kasey Foley, R.E.H.S. <br />lel' # : ► ,x 1 it '• : # : 1a ! A�t/:� I�II�[L��1��� 7,y1�1�� <br />This packet contains the information and forms you will need to Delp you comply with the <br />Medical Waste Management Act. <br />]Tease return the completed forms prior to medical waste generation or treatment. <br />1. Complete the "Pre -Application Questionnaire" on Page 2. If your answers indicate <br />you are not required to register as a medical waste generator, then complete the <br />66Certification Statement" on Page 3 and return both complete forms to the mailing <br />address below. <br />2. If you are required to register as a medical waste generator, as indicated by affirmative <br />answers to questions 3 & 4 on the "Pre -Application Questionnaire", then: <br />a. Complete the "Registration for Medical Waste" form located on <br />Page 4. <br />b. Complete a "Medical Waste Management Plan" following the guidelines <br />provided on Page 5. <br />c. Return the completed forms and management plan to the mailing address <br />below. <br />Your cooperation in promptly registering and following the specified handling requirements is <br />greatly appreciated. <br />If you have any questions regarding registration or handling requirements, please contact (209) <br />468-3420 and ask for the Medical Waste Program. <br />RETURN ALL COMPLETED ]FORMS TO: <br />Attn: Medical 'Waste Program <br />San Joaquin County Environmental Health Department <br />600 East Main Street <br />Stockton, CA 95202 <br />S14D 45-03 WEB <br />04/18/08 <br />