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II (a) <br /> REGISTRATION/PERMIT APPLICATION <br /> FOR <br /> MEDICAL WASTE GENERATION AND TREATMENT <br /> As of January 1991, all generators of regulated medical waste are subject to <br /> the registration requirements pursuant to the Medical Waste Management Act. <br /> To register your facility, complete and send this application along with a <br /> medical waste management plan (if applicable) , and the permit fee (see fee <br /> schedule) to: Department of Health Services, Medical Waste Management <br /> Program, P. O. Box 942732, MS# 396, Sacramento, CA 94234-7320. <br /> Note: This application will not be processed until all required <br /> information has been received and fee(s) have been submitted. <br /> LOCATION OF GENERATOR: (Please Print or Type) <br /> . h <br /> Business Name: <br /> ry <br /> Business Address: <br /> City: 6TxkgAT State: <br /> zip: County: A-IVIIAI <br /> Authorized Representative: VIV14N 26&-Rau W <br /> Title: �MIM6T&TffPhone Number: 4757 - U36- <br /> TYPE OF GENERATOR: (Check One) <br /> V/) Small Quantity Generator - If your facility generates less than 200 lbs <br /> of medical waste a month. <br /> ) Small Quantity Generator with Onsite Treatment - If your facility <br /> generates less than 200 lbs a month and treats the medical waste onsite <br /> by autoclaving, incinerating or microwaving. <br /> ) Large Quantity Generator _ - If your facility generates 200 lbs or more <br /> of medical waste a month and hires an authorized registered hazardous <br /> waste hauler to pick up the medical waste for proper disposal. <br /> ) Large Quantity Generator with Onsite Treatment <br /> If your facility generates 200 lbs or more a month and treats the <br /> medical waste onsite by autoclaving, incinerating or microwaving. <br /> Common Storage Facility Permit <br /> Any designated accumulation area which is onsite and is used by small <br /> quantity generators otherwise operating independently for the storage of <br /> medical waste for collection by a registered hazardous waste hauler. <br /> If you are registering as a medical waste generator, please continue to fill <br /> out the reverse side of this form. If you do not generate regulated medical <br /> waste, please complete pre-application questionnaire for declaration of non <br /> medical waste generators. <br /> (2/94) <br />