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V <br />.. <br /><bf <br />0 CT 16 10991 <br />CERTIFICAnON ATE <br />F I T I .G RS <br />REGISTERNOT REQUIRED TO <br />(Please a or Print) <br />BUSINESS DHARNIDHARKA, INC. dba ARTIFICIAL KIDNE MEDICAL CLINIC <br />BUSINESS S: <br />Street 2350 N. CALIFORNIA STREET <br />Ci S CKTON State CA Zip 95204 <br />PHONE BER: 2�9 943-0854 <br />NAME OF I%'er <br />Clark stin, Chief Technician <br />I of oe t : <br />[Please check the approeme <br />. •- <br />I generate less than 200 <br />I do not treat any <br />incinerating or . <br />MIT <br />Please Indica The Appropriate Statement(s): <br />( I d l a under penalty of law that to the best of my wledge and belief, I do not <br />erre or store any of the wastes specified on the' - pplication QuestionnaiW <br />s "Regulated Medical WastW in an amount over 200 p ds per month. <br />I declare under penalty of law that I will not be treating any ount of "Regulated <br />Medical Wastes" at my facility y way of autoclaving, incinera g, or n-dcrowaving. <br />SIGH ° : General Manager Dq 9/19/91 <br />40 . If <br />