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SAK�JOAQUIN Envirotental Health Department <br /> —COUNTY— <br /> Registration for Generators of Medical Waste <br /> Generator Name: Tracy Dialysis Care <br /> Generator Facility Address: 425 W Beverly PI <br /> Tracy, CA 95376 <br /> City State Zip Code <br /> Phone Number: ( 209 ) 839.0398 <br /> Generator Mailing Address: 425 W Beverly Pl. <br /> City State Zip Code: Tracy, CA 95376 <br /> Type of Business: Dialysis / Healthcare <br /> Authorized Representative: : Courtney Vela <br /> Title: Facility Administrator <br /> Emergency Phone Number:( 209 ) 839.0398 <br /> Registration for: <br /> El Small Quantity Generator with Onsite Treatment (Generates less than 200 lbs/month). <br /> 14 Large Quantity Generator Only (Generates 200 lbs or more/month). <br /> E] Large Quantity Generator with Onsite Treatment (Generates 200 lbs or more/month). <br /> I declare under penalty of law that to the best of my knowledge and belief the statements made <br /> herein are correct and true. I hereby consent to all necessary inspections made pursuant to the <br /> California Medical Waste Management Act and incidental to the issuance of this registration and the <br /> operation of this business. <br /> Signature:_C�&Zzt�tla& Title: Facility Administrator Date: 10/03/2019 <br /> 5 Of 11 <br />