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0 0 <br />Certification Statement <br />FOR NON -;MEDICAL WASTE GENERATORS AND MEDICAL WASTE GENERATORS NOT REQUIRED TO REGISTER <br />Business Name: � .e r ('�� D c ?`o �J rY1 n r c a L d FKtcC A3t ,Q, ei jjd 4ar4q <br />0 Cru Te.L <br />Business Address: Z.S"DS ,�✓✓c,umE.e ,GA.✓C <br />S''T'oc3J�✓ LAR 95.2oq <br />City state Zip Code <br />Phone Number: (1 q ) !2.5, " --;zoo / 00L 201? -:2-2 0 <br />Contact Person: AA ,AVO Z�rr "I <br />I am not required to register as a Medical Waste Generator because: <br />Please check the appropriate statemernt(s) <br />❑ 1 do not generate any medical waste. <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, incinerating or <br />microwaving. <br />❑ - Other: <br />Please indicate the appropriate statement(s): <br />❑ I declare under penalty of law that to the best of my knowledge and belief, I do not generate or <br />store any of the wastes specified on the "Pre -Application Questionnaire" as regulated medical <br />`vastes in an amount that equals or exceeds 200 pounds per month. <br />I declare under penalty of law that I will not be treating any amount of regulated medical wastes <br />at my facility by way of autoclaving, incinerating or microwaving. <br />Signature: <br />EHD 45-03 3 <br />10/6/2003 <br />d <br />