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0 <br /> lorCEIVED <br /> V 0 4 1991 <br /> G <br /> TION FORDI ,5NMENTAL HEALTH <br /> (Please Type or Print) ;' <br /> GENERATOR NAME: SAN JOAQUIN COUNTY PUBLIC HEALTH LABORATORY <br /> GENERATOR FACILITY ADDRESS: <br /> Street 1601 E. HAZELTON AVENUE <br /> Clay STOCKTON State CA Zip 95205 <br /> Phone Number (209 ) 468-3460 <br /> GENERATOR MAILING SS: <br /> Street P.O. BOX 2009 <br /> •ty STOCKTON State CA Zip 95201 <br /> TYPE OF BUSINESS: PUBLIC HEALTH LABORATORY <br /> AUTHORIZEDREPRESENTATIVE: Dennis V. Ferrero <br /> TITLE: Director, Public Health Laboratory <br /> EMERGENCY PHONE NUMBER: L-L21-462-85& ask for Environmental Health <br /> answering # PHS <br /> REGISTRATION FOR: <br /> (Check One) <br /> O Small Quantity Generator With Onsite Treatment. (Generates < 2001bs./mo.) <br /> OLarge Quantity Generator Only. (Generates 200 or more lbs./mo.) <br /> (X) Large Quantity Generator With Onsite Treatment. (Generates 200 or more lbs./ o.) <br /> Also use biohazardous waste hauler. <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 /> SIGNA • A lig" <br /> d TITLE: Director DA / riI <br /> 6 <br />