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EHD Program Facility Records by Street Name
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4500 - Medical Waste Program
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PR0518732
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Last modified
2/21/2023 1:18:33 PM
Creation date
7/3/2020 10:22:41 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4500 - Medical Waste Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0518732
PE
4557
FACILITY_ID
FA0014107
FACILITY_NAME
SUTTER VNA & HOSPICE - TRACY OFFICE
STREET_NUMBER
4600
Direction
S
STREET_NAME
TRACY
STREET_TYPE
BLVD
City
TRACY
Zip
95377
APN
24864001
CURRENT_STATUS
02
SITE_LOCATION
4600 S TRACY BLVD 101
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\cfield
Supplemental fields
FilePath
\MIGRATIONS\MW\MW_4557_PR0518732_4600 S TRACY_.tif
Tags
EHD - Public
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San Awn County Public Health ServiC=SO <br /> Environmental Health Division <br /> Medical Waste Management Program <br /> APPLICATION FOR A LIMITED QUANTITY HAULING EXEMPTION <br /> To qualify for a"Limited Quantity Hauling Exemption'* pursuant to the ",Medical Waste Management Actt% the following <br /> conditions must be met <br /> The generator or health care professional generates less than 20 pounds of medical waste per week, transports less <br /> than 20 pounds of medical waste at any one time, maintains a tracking document pursuant to Chapter 6, and the <br /> generator or parent organization has on fife one of the following: <br /> Medical Waste Management Plan if the generator or parent organization is a large quantity genehator or a small <br /> quantity generator required to register pursuant to Chapter 4. <br /> 2- Information Document if the generator or parent organization is a small quantity generator not required to <br /> register pursuant to Chapter 4. <br /> PLEASE COMPLETE THE INFORMATION BELOW AND MAIL WITH S67 FEE TO: PAYMENT <br /> San Joaquin County Public Health Services RECEIVED <br /> Environmental Health Division JAN 15 2003 <br /> Medical Waste Management Program <br /> 304 E Weber Ave SAN JOAQUIN COUNTY <br /> PUBLIC HEALTH SERVICES <br /> Stockton, CA 95202 EWIRTN10ENTXL hll,:�!_TH Y:�Sl \ <br /> Medical Waste Hauler Information <br /> 0 New I&Renewal <br /> Medical office/Business Name:__ <br /> Medical Office/Business Address:-- <br /> State:- Zip Code: <br /> City: k- Phone t <br /> Contact Persone e <br /> Storage Facility Name:— <br /> Storage Facility Address: State: C <br /> ,8= _Zip Code: 4k,; <br /> City: <br /> Permitted Treatment Facility Name: f <br /> Permitted Treaftdnt Facility Address: <br /> State: Zip Code: <br /> City: U <br /> List all employee names and titles; authorized to transport the medical waste. If not enough space, attach information. <br /> I- Name: Tide: <br /> Title: <br /> 2- Name: Title: <br /> 3- Name: <br /> A copy of this exemption and a tracking document shall be in employee's possession at all times while transporting medical waste. in <br /> addition, all copies of medN I waste records shall be kept on file at generators or health care professional's facility. <br /> Applicant Signature: Date:_1_/ 02�� <br /> Title: <br /> Do Not Write Below This Line <br /> ------------------- <br /> R.E.H.S. Application Approval: <br /> Date: �110 Expiration Date: <br /> Date <br /> Cash otr<, (circle) Acct <br /> EH4502 1"3-96 Date Paid ash ot� LL221.a <br />
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