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CERTIFICATION STATEMENT <br /> FOR NON-MEDICAL WASTE GENERATORS AND MEDICAL WASTE GENERATORS <br /> NOT REQUIRED TO REGISTER <br /> (Please Type or Print) <br /> BUSINESS NAME: Olsten Health Services <br /> BUSINESS ADDRESS: <br /> Street 1588 East March Lane Suite B- <br /> City Stockton State CA Zip 95210 <br /> NAME OF RESPONSIBLE PERSON: Dana Wolucka <br /> PHONE NUMBER: ( 209) 474-7881 <br /> I Am Not Required To Register As A Medical Waste Generator Because: <br /> [Please check the appropriate statement(s).] <br /> I do not generate any medical waste. <br /> x I generate less than 200 pounds of medical waste per month. <br /> x I do not treat any medical waste at my facility by means of autoclaving, incinerating or <br /> microwaving. <br /> Other <br /> Place an "X" next to the corresponding method your facility uses to dispose of medical waste: <br /> x Registered Medical Waste Transporter Integrated Environmental Systems (transporter name) <br /> _ Alternative Technology Approved by DHS (treatment method) <br /> I declare under penalty of law that to the best of my knowledge and belief, I do not generate or store any <br /> of the wastes specified on the "Pre Application Questionnaire" as "Regulated Medical Wastes" in an <br /> amount over 200 pounds per month. I also declare that I will not be treating any amount of"Regulated <br /> Medical Wastes"at my facility by way of autoclaving, incinerating, or microwaving. <br /> SIGNATURE. TITLE:Asst. SecretaryDATE: 9/2/99 <br /> (NOTE: IF YOU FILL OUT"CERTIFICATION"FORM DO NOT FILL OUT'REGISTRATION FORM) <br /> 3 <br />