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FIFTH F-LOOR <br /> PAG E Q2 <br /> PAYMENT <br /> San j,,laqt�In lcounty, Public, Heaidl Ser iic-ns RECEIVED <br /> ,_nvjr, nr,qer,ta1 Fiesith Divis4on MAR 13 2003 <br /> Medr-al bVaste Managernent PI`cgrari" <br /> SAN JOAQUIN COUNTY <br /> APPLICATI,ON FOR A, LIMITED QUANTi-rf HAULING EXEMPT IGN PUBLIC HEALTH FARM <br /> ENVIRONMENTA[.HELTH DIVISION <br /> ('111slitity Hafiing Exarr#on" pursuant to d-le '1;vjedjCjBj aNa�ate Nrlaflegernent Ac—,*, dip; 10Slawirig <br /> be met: <br /> [eq 4-,an 20 OCUrdS Me.d�k2tWOSUZ' Pec.Wee�, h-'111SPOC'S '�S <br /> Care P,101aSsional qeM <br /> Me It - <br /> at any one nme, mainzafns a tr��c!-�ng dax,,r,r.ent pursuant t anapter 6, and tAne <br /> a, of medion-i wzste t <br /> (ar- -,are-mt organization has Qn z1fle one of the foilowirlg: <br /> _;Sj la ,Wanagememt Plan "firile <br /> generator required to revliszer alt.rsupant to Chapter A, <br /> ma;j clot rrzquired tc <br /> r3j-&-mavcn Document if the genarazC;r Or 08rerit "rgnr"zs011 is a s <br /> registar pursuant to Chapter 4. <br /> CLONXPLETE THE NFORMATION SELOW A?4D -MAIL WFH $67 F-=-m T. <br /> "an joaqui:' County ptjbtic Health Sertrices <br /> Z <br /> Eli 1-2,eaith Division <br /> Y'laste �',Inn-gerp.ent Program <br /> --er Ave <br /> -A <br /> aijjer Information <br /> Medical Waste p <br /> Renevial <br /> 0�dm�- " <br /> Name: <br /> tip C,)de: <br /> < <br /> ......=wft <br /> T <br /> I aj e(npti:.yee n2mes aild tmrisport ttIe rnedrA wsl�re. if <br /> at while.trarapatting me'd1=41 way. ta. in <br /> rrptton and a tracking of n nfftmr�OW5 fa ty <br /> 1edIc_j-was, <br /> rucard_� 5,haa ba kept an ile at genefatues Or Ila2IIh aftte P <br /> T'l <br /> Not write .'ejaw —ink Line <br /> 4EXPirate on Date-. I, <br /> 2-f - 0_3 <br /> ovalL __.Dat <br /> Appr <br /> tc;rde) Am_1grt5 17m <br /> ash <br /> Cate F�id M_i]4�cl <br /> 0& <br />