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SA l V J O (t; Q I I N Environmental Health Department <br /> CGUuUi\jTy . <br /> Large Quantity Generator ( LQG ) Facility Category ( defined in HSC 117995 ) : <br /> F1Acute Care Hospital <br /> kfPrimary Care Clinic <br /> Skilled Nursing Facility <br /> Veterinary Clinic <br /> Other LQG <br /> I declare under penalty of law 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 of <br /> this business . <br /> Signature : <br /> Name and Title : <br /> Date : to <br /> Version . 8 3-23 Page 4 of 11 <br />