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S A N A A Q U I N , Environmental Health Department <br /> COUNTY-- <br /> Large Quantity Generator (L.QG) Facility Category(defined in HSC � 1� 17995): <br /> ❑ Acute Care Hospital <br /> ❑ Primary Care Clinic <br /> ❑ Skilled Nursing Facility <br /> ❑ Veterinary Clinic <br /> IA Other L.QG <br /> I declare under penalty of law that to the best of my knowledge and belief the statements made herein <br /> are correct and true. l hereby consent to all necessary inspections made pursuant to the California <br /> Medical Waste Management Act and incidental to the issuance of this registration and the operation of <br /> this business, <br /> Signature: L� <br /> a <br /> Name and Title <br /> Date; <br /> 4of11 <br /> i <br />