Laserfiche WebLink
REGISTRAMON FOR it <br />(Please Type or Print) <br />WM3 ITOWMIM1.114 HAM F.W41N � IM I oil 00 WN 4 1 � I tim <br />Street 2350 N. California Street <br />City Stockton — State CA , ..-- Zip 25204 <br />Phone Number ( 209 ) 943-0854 <br />=6 <br />2350 N. California Sstreet <br />City Stockton State CA Zip 95204,, <br />TYPE OF BUSINESS: Medical office and Dialysis Clinic <br />AUTHORIZED REPRESENTATIVE: Clsirk Austin <br />TITLE: <br />Chief Technician <br />EMERGENCY PHONE NUMBER. ( 209 ) 943-0854 <br />REGISTRATION FOR: <br />(Check One) <br />Small Quantity Generator With Onsite Treatment. (Generates < 200 lbs./mo.) <br />9V Large Quantity Generator Only. (Generates 200 or more lbs./mo.) <br />Large Quantity Generator With Onsite Treatment. (Generates 200 or more lbs./mo.) <br />I declare under penalty of law that to the best of my knowledge and belief the statements <br />made herein are correct and true. I hereby consent to all necessary inspections made <br />pursuant to the California Medical Waste Management Act and incidental to the issuance <br />of this registration and the operation of this business. <br />SIGA:General ?MnUdDATE: 9/19/91 <br />�-j <br />