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<br />4 of 8 <br /> <br />Environmental Health Department <br />Registration for Generators of Medical Waste <br /> <br />Generator Name: <br />Generator Facility Address: <br /> <br /> <br />City State Zip Code <br /> <br />Phone Number: ( ) <br /> <br />Generator Mailing Address: <br />City State Zip Code <br /> <br />Type of Business: <br /> <br />Authorized Representative: <br /> <br />Title: <br /> <br />Emergency Phone Number: ( ) <br />Registration for: <br /> Small Quantity Generator with Onsite Treatment (Generates less than 200 lbs/month). <br /> Large Quantity Generator Only (Generates 200 lbs or more/month). <br /> Large Quantity Generator with Onsite Treatment (Generates 200 lbs or more/month). <br /> <br />I declare under penalty of law that to the best of my knowledge and belief the statements <br />made herein are correct and true. I hereby consent to all necessary inspections made <br />pursuant to the California Medical Waste Management Act and incidental to the issuance of <br />this registration and the operation of this business. <br /> <br /> <br />Signature:_______________________ Title:_________________________ Date:_________ <br /> <br /> <br /> <br /> <br />CSL Plasma <br />29 E. March Ln. <br />Stockton CA 95207 <br />900 Broken Sound Parkway, Boca Raton, FL 33487 <br />Blood plasma collection facility <br />Barbara Wunder <br />Director EHS <br />303 886-6721 <br />303 886-6721 <br />Director EHS 3/24/2021