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Environmental Health Department <br /> SAN��JOAQUIN � p <br /> -------C O U N T Y j <br /> Medical Waste Facility Registration <br /> Facility Name: <br /> Facility Address: y � a: I�1 '► Yl - ,�t <br /> .� <br /> i <br /> City, State, Zip Code: ' ( <br /> Mailing Address; <br /> City, State, Zip Code: <br /> Phone Number: <br /> Facility Contact and Title: rc- ► }2 ?C��j°iLL !J y �'SC <br /> a- ' vrC� <br /> Facility Registration Category: <br /> ❑ Small Quantity Generator(<200 pounds per month)with Onsite Treatment. <br /> II Large Quantity Generator(>=200 pounds per month)with Onsite Treatment. <br /> ❑ Large Quantity Generator(>=200 pounds per month)without Onsite Treatment. <br /> ❑ Common Storage Facility (2-10 generators) <br /> ❑ Common Storage Facility (11-50 generators) <br /> ❑ Common Storage Facility(> 50 generators) <br /> 3of11 <br />