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ENVIRON*ENTAL HEALTH DF.UARTMENT <br />304 Last Weber Avenue, Third Floor c <br />DfreClnr <br />Al 01acn, RMMS. Stockton, California 952M Mike H° RZ.t�.s., "X <br />Program MatkVerDenewW. W! RX -Oz. <br />8 R. <br />Telephone: (209) 468-3420 . <br />Laurie A. m Prvgram mer Pax: (209) 468-3433 Rabext V -L". <br />rxark Ramo s, . <br />This packet contains the information and forms you will need to help you comply with the <br />Medical Waste Management Act. <br />fast Ctions <br />Please return the completed forms prior to medical waste generation or treatment, <br />I . Complete the "Pre -Application Questionnaire" on Page 2. If your answers indicate <br />you are not required to register as a medical waste generator, then complete the <br />Certification Statement" on Page 3 and return both complete forms to the mailing <br />address below. <br />2. If you are required to register as a medics) waste generator, as indicated by affirmative <br />answers to questions 3 & 4 on the "Pre -Application Questionnaire°', then: <br />A. Complete the "Registration for Medieal Waste" form located on <br />Page 4. <br />b. Complete a "Medical Waste Management Flan" following the guidelines <br />provided on Page 5. <br />c. Return the completed forms and management plan to Kasey Foley at the <br />trailing address below. <br />Your cooperation in promptly registering and following the specified handling requirements is <br />greatly appreciated. <br />If you have any questions regarding registration or handling requirements, please contact <br />Kasey Foley at (2o9) 4$g-3451. <br />RETURN URN ALL COMPLETED FORMS TO; <br />Kasey Foley, R.&ILS., Medical Waste Progmm <br />San Joaquin County Environmental Health Department <br />304 East Weber Avenue, 3rd. Floor, Stockton, CA 95202 <br />N®V 14 2005 <br />EHD4M2-003 Page l 01 % e%j kjEhjH <br />Ia n gAMIR Nm sERvtcEs <br />ptR <br />