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' e8/'LW�c16 00P '0®.10•38A RAa j L. BROWN D.C FIFTH FLOM Pr-'.%E 82 <br /> Stn Joaquin <br /> /y, Public Health Services <br /> nmental <br /> isW <br /> Medical Vitaste Management Pirogrom <br /> APPLICATION FOA A LIMITED I H UUNG EXEMPTION <br /> To qWMV for a' LiasQuantity Hau&q Exemption" nt to the Vedical MWta Manwment Acv. the fvtiowing . <br /> owtditions must be met, <br /> The generator or health care professional generates lea than 20 pounds of mediW waste per week. tans less' <br /> than 20 pounds of medical waste at any ons time. maintairs a tracking document pu+Suant to CWpter a, and 018 <br /> generator or parent organ&0bon has on fila one of the Following: <br /> 1- medlcat VlrWasta MaR meat Pion if the generator or parent argankBillon is a laW quantity generator or a small <br /> quantity gqnemtor required to register puChapter 4. <br /> 2- latwmaHm Doovmant if the generator or parent organkallon is a, small quantity generator not required to <br /> register pursuant to Chapter 4. <br /> ASE COMPLETE. INFORMATION BELOW, MAL W -. . <br /> Son Joaquin County Public-Health Services <br /> Environmental Heolth Division <br /> Medica! Waste Management Program <br /> 304 E Weber Ave <br /> Stockton, CA 95202 <br /> Medical Waste Hauler Information. <br /> O NewRe al <br /> MedkW® Business Nattte: <br /> MedicalOffice(BUsiness 88: <br /> city: p <br /> Contact person: S Phonegot <br /> — p <br /> Storage Facility Flame: C— 1*V%Ix e�k <br /> Storage Facie' Add <br /> City: State;,� Zip Cod®, <br /> Permittee! Treatment FaciNty Name: .. <br /> -- <br /> Pd Tte Facility <br /> City; MK —' p e: <br /> t.lst all employee names ltd titles authortaed to trang4rt the rnadiNI Mte. if not VItough wace, aftach Informs il . <br /> Nara: 4A4 Tft <br /> 2- Name. Tole: - <br /> 3- Name: <br /> A Copy dmnWaan wW a ua.raft 11ftUMM SMI'bR s 's i$ a'alt Medical vmbL in <br /> ad 9W=Of RWHft21 waste ro shsQ ba 610p4 or h9aith Caw prikWonaft recopy. <br /> Applicant S' atu <br /> `Y'Itle• Det <br /> 00 Not write I This bine.� <br /> R.E.KS.,Application Approval Date: Exptrat�aA Date , / <br /> IS4502 1 �ft8 P$l�l 'Cash Or � lcircta' A <br />