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SAN JOAQUIN <br />COUNTY <br />Environmental Health Department <br />Large Quantity Generator (LQG) Facility Category (defined in HSC $ 117995): <br />1-1 Acute Care Hospital <br />Primary Care Clinic <br />❑ Skilled Nursing Facility <br />❑ Veterinary Clinic <br />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: <br />Date: 8-18-25 <br />Nicasio Lopez, Associate Hazardous Materials Specialist. <br />Version: 7-1-25 Page 4 of 11 <br />