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SA N J O A Q U I N Environmental Health Department <br /> COUNTY- <br /> Large Quantity Generator(LQG) Facility Category(defined in HSC $ 117995): <br /> ❑ Acute Care Hospital <br /> ❑ Primary Care Clinic <br /> Skilled Nursing Facility <br /> ❑ Veterinary Clinic <br /> x] Other LQG <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. I 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: <br /> Name and Title: Nicasio Lopez, Associate Hazardous Materials Specialist. <br /> Date: 8-18-25 <br /> Version:7-1-25 Page 4 of 11 <br />