Laserfiche WebLink
0 CT <br /> 0 2 1, 9{j <br /> A <br /> FOR NON-MEDICAL WASTE GENERATORS AND MEDICAL WASTE GENERATORS <br /> NOT REQUIRED TO REGISIR <br /> (Please Type or Print) <br /> BUSINESS E: DELTA VALLEY CONVALESCENT HOSPITAL <br /> BUSINESS ADDRESS: <br /> Street 1032 N. LINCOLN <br /> City STOCKTON State CA Zip 9 5 2 0 3 <br /> PHONE NUMBER: (?09 ) 4 66-53 41 <br /> NAME OF RESPONSIBLE PERSON: Rilda Scarfo <br /> I Am Not Required To Register As A Medical Waste Generator : <br /> [Please check the appropriate statement . <br /> I do not generate any medical waste. <br /> I generate less than 200 pounds 'c to per month. <br /> I do not treat any medical waste at my facility by means of autoclaving, <br /> incinerating or microwa ' g. <br /> Other <br /> Please Indicate The Appropriate Statement(s): <br /> OQ I declare under penalty of law that to the best of my knowledge and belief, I do not <br /> generate or store any of the wastes specified on the' e-Application Questionnaire" <br /> as "Regulated Medical WastW in o t over 200 pounds per month. <br /> I declare under penalty of law that I will not be treating any amount of"Regulated <br /> Medical Wastes"at my facility by wayf autoclaving, incinerating, or microwaving. <br /> SIGNATU ' E: M�` DATE: <br />