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ENVIRONMENTAL HEALTH DEPARTMENT <br />oP4�fM. SAN JOAQUIN COUNTY <br />Q 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax (209) 468-3433 <br />c;<<FORN;` • <br />INFORMATION PACKET FOR MEDICAL WASTE GENERATORS <br />This packet contains the information and forms you will need to help you comply with the <br />Medical Waste Management Act. <br />Instructions <br />Please return the completed forms prior to medical waste generation or treatment. <br />I Complete the "Pre -Application Questionnaire" on Page 2. If your answers indicate <br />you are not required to register as a medical waste generator, then complete the <br />"Certification Statement" on Page 3 and return both complete forms to the mailing <br />address below. <br />2. If you are required to register as a medical waste generator, as indicated by affirmative <br />answers to questions 3 & 4 on the "Pre -Application Questionnaire", then: <br />a. Complete the "Registration for Medical Waste" form located on <br />Page 4. <br />b. Complete a "Medical Waste Management Plan" following the guidelines <br />provided on Page 5. <br />c. Return the completed forms and management plan to the mailing address <br />below. <br />Your cooperation in promptly registering and following the specified handling requirements is <br />greatly appreciated. <br />If you have any questions regarding registration or handling requirements, please contact (209) <br />468-3420 and ask for the Medical Waste Program. <br />Attn: Medical Waste Program <br />San Joaquin County Environmental Health Department <br />1868 East Hazelton Avenue <br />Stockton, CA 95205-6232 <br />EHD 45-03 WEB <br />04/18/08 <br />