Laserfiche WebLink
Registration for Medical Waste <br /> For Generators of Medical Waste <br /> GENERATOR NAME: Arbor5i pi�i Cie <br /> Generator Facility Address: 02 10 , Ck 94- <br /> /-062(* G CS <br /> City State Zip Code <br /> Phone Number: ( 2®`i ) 3 3-3 ' 1 -21- <br /> Generator Mailing Address: a <br /> City State Zip Code <br /> Type of Business: <br /> Authorized Representative: Tv� c��� !✓� <br /> Title: e C c-c-�',`V I��✓ e c, "c� <br /> Emergency Phone Number: ( 2®5 ) 3 3 3 <br /> REGISTRATION FOR: <br /> ❑ Small Quantity Generator with Onsite Treatment(Generates less than 200 lbs/month). <br /> Large Quantity Generator Only(Generates 200 lbs or more/month). <br /> ❑ 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: e rc� `�,, Date: <br /> EHD 45-03 4 <br /> 2015 <br />