Laserfiche WebLink
Pegistration <br />Waste- <br />For t - Waste <br />GENERATOR NAME: RAI -N. Califfbmi et <br />Generator Facility Address: 2350 North California Street <br />smoddon CA 95204 <br />City State Zip Code <br />Phone Number: ( 209 ) 943-0854 <br />Generator Mailing Address: Same as above <br />City State Zip Code <br />Type of Business: End Stage Ronal picanse (ESRD) 0ā€”uā€”t anent iarillty <br />Authorized Representative: <br />Title: center Director <br />Emergency Phone Number: >Ed -of ) %2,5 6- --- <br />a - T <br />REGISTRATION FOR: <br />ā‘ Small Quantity Generator with Onsite Treatment (Generates less than 200 lbs/month). <br />® Large Quantity Generator Only (Generates 200 IN or more/month). <br />ā‘ 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 con*d and true. I hereby consent to all necessary inspections made pursuant to the California <br />Medical Waste Management A,et and incidental to the issuance of this registration and the operation <br />of this business. <br />Signature: <br />BHn as -M -M g <br />WuftAi Page 4 of 7 <br />