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LT <br />RE-GISTR.A-flON FOR WDICAL <br />(Please Type or PrifiO <br />IS 7 <br />GENERATOR NAME: <br />NY k-0Statee,e zip • S-2 K -2 - <br />Phone <br />city Z 0 - State Mrf- Zip <br />TYPE <br />• BUSINESS: Pla"Iki;-C <br />AUTHORIZED •• <br />EMERGENCY • NUMBER: (2--Z ZZ vd <br />REGISTRATION FOR: <br />(Check One) <br />O Small Quantity Generator With Onsite Treatment. (Generates < 200 lbs./mo.) <br />Large Quantity Generator Only. (Generates 200 or more lbs./mo.) <br />• Quantity Generator With • Treatment. (Generates 200 • • lbs./mo.) <br />1�,i! -9-z-a-1,ozif txi�-=twwor <br />made herein are correct and true. I hereby consent to all necessary inspections ma <br />pursuant to the California Medical Waste Management Act and incidental to the issuan <br />of this registration and the operation of this business. <br />Z <br />SIGNATURE: TITLE: DATE: <br />6 <br />