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ONO'ON W ��,;Z Z[06 'til '2ny ;WI j paAi;3;a <br />Registration. f®r !Medical 'waste <br />For Generators of Medical Waste <br />GENERATOR NAME: e - e, \j &0,faZAS <br />Generator Facility Address: 15 `i E. <br />8 <br />S-Yo <br />City State Gip Code <br />Phone Number: Lana q 5 I—-4 S-3 9 <br />Generator Mailing Address: VNal O ck <br />SA---Qr� . CA asci® <br />City State Gip Code <br />Type of Business: ��,eit�',C� NtJl,i t1(lq, Gt.G.S�t�V <br />Authorized Representative: <br />Title: . ��tw_'�°ty �. t li F—Cf' O r <br />Emergency Phone Number: (;Loc) !3 5 ? — 115:N <br />REGISTRATIONFOR: <br />❑ Small Quantity Generator with Onsite Treatment (Generates less than 200 lbs/month). <br />1 Large Quantity Generator Only (Generates 2001bs or more/month). <br />❑ barge 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: <br />END 45-03 <br />10/6!2003 <br />OV / d 26£889 60? <br />4 <br />G�:�L �L-90-ZLOZ <br />