Laserfiche WebLink
0 <br /> Registration Medical Waste <br /> .For Generators of Medical Waste <br /> GENFRATOIR NAME: <br /> Generator Facility Address: <br /> City State Zip Code <br /> Phone Number: <br /> Generator ^^,,�---- <br /> Mailing Address: ? <br /> q<�O <br /> city State Zip Code <br /> Type of Business: <br /> Authorized Representative: <br /> Title: 11 7 <br /> Emergency Phone Number: <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 Is or more/month). <br /> I declare under penalty of law that to the best of ray 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 /> Signature: Title: Date: <br /> EIM 45-03 <br /> Received Time Aug. 1, 2016 12: 57PM No, 1609 4 <br />