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wm <br />F �{ <br />s AML 6-`v . � 4 t <br />l F'' C M 3 s <br />T 11 <br />E VIIRONF0E TAS. 61EA' TL <br />CERTIFICATION Al E 16T,"SER V1C <br />FOR NON-MEDICAL ATORS AND MEDICAL WASTE GENERATORS <br />NOT REQUIRED TO REGISTER <br />(Please Type or Print) <br />BUSINESS NAME: ARTEL, Inc., ... Lodi Outpatient <br />Street 521 S. Ham Lane Suite F <br />City Lodi State CA Zip 95242 <br />PHONE NUMBER: ( 2 0 9) 333-0905 <br />(PleaseI Am Not Required To Register As A Medical Waste Generator Because: <br />► i • <br />+. not generatemedical <br />- I generate less than 200 pounds of medical waste per month. <br />I do not treat any medical waste at my facility by means of autoclaving, <br />incinerating ormicrowaving. <br />Other <br />MedicalI declare under penalty of law that to the best of my knowledge and belief, I do <br />generate or store any of the wastes specified on the "Pre -Application Quest*o <br />as "Regulated Medical, Wastes", in an amount over 200 pounds per month. <br />I declare under penalty of law that I will not be treating any amount of "Re <br />Wastes"at my facility• ,way ofautoclavmig,inemierating, or jjt <br />r microwavin <br />SIGNA DATE: <br />91 <br />