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• • <br /> Registration for Medical Waste <br /> For Generators of Medical Waste <br /> GENERATOR NAME: SAN JOAUQIN DELTA COLLEGE SOUTH CAMPUS AT <br /> MOUNTIAN HOUSE <br /> Generator Facility Address: 2073 South Central Parkway <br /> Mountain House CA 95391 <br /> City State Zip Code <br /> Phone Number: (209)954-5835 <br /> Generator Mailing Address: 5151 Pacific Avenue <br /> Stockton CA 95207 <br /> City State Zip Code <br /> Type of Business: Community College <br /> Authorized Representative: Stacy Pinola <br /> Title: Facilities Planning&Environmental Compliance Manager <br /> Emergency Phone Number: (209)609.6033 <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 lbs or more/month). <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 <br /> of this business. <br /> Facilities Planning <br /> Environmental Compliance <br /> Signature: Title: Manager Date: 3/3/17 <br /> EHD 45-03 4 <br /> 2015 <br />