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Registration for Medical Waste <br /> For Generators of Medical Waste <br /> GENERATOR NAME: Vienna Nursing and Rehabilitation Center <br /> Generator Facility Address: 800 South Ham Lane <br /> Lodi, CA 95242 <br /> City State Zip Code <br /> Phone Number: (209) 368-7141 <br /> Generator Mailing Address: 800 South Ham Lane <br /> Lodi, CA 95242 <br /> City State Zip Code <br /> Type of Business: Nursing Home—Skilled Nursing Facility <br /> Authorized Representative: Corey Wright <br /> Title: Administrator <br /> Emergency Phone Number: (209) 368-7141 <br /> REGISTRATION FOR: <br /> Small Quantity Generator with Onsite Treatment(Generates less than 200 lbs/month). <br /> El Large Quantity Generator Only(Generates 200 lbs or more/month). <br /> 0 Large Quantity Generator with Onsite,Treatment(Generates 200 lbs or more/month). <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 <br /> of this business. <br /> Signature: Title: <br /> EHD 45-03 <br /> 1016/2003 4 <br />