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VWWHOG @8:31 209-4E 41 PHS CLINIC PAGE 02/05 <br /> r :w csr-f a P 2 <br /> San Joa ulh County Public Health Servioes <br /> Environmental Health Division coip <br /> Medical Waste anag ept Program <br /> APPLiCATION FOR A LIMITM QUANTITY HAULING EXEMPTION <br /> To qualify fur a'Limited Quani0tyHaul x9mp totl"pursuant to",-Medlval Management Aer', the fo lowing <br /> cold'tionc must be met: <br /> The genelstor or health caro,�,mfwukxiai generateo km Umn 20 pounds Ca?` <br /> ,wi 20 pounds a modkift;.,-4008f nvY one time, MW"tAdMs a tmoltlng. document pureugrit to Chaptar 6, ano the <br /> qanoraWr or pamW a �mizW4on hm on Me one or Me fallo fnp: <br /> 1W A40,0kal Waste Managemenr Plan ff thepmeraWr or pamrit orgaqIzat1cm is a large qua-mIty generator or a c mall <br /> QUanW sWfor Inquired Fstp-r puMU&ft 10 Chapiler 4, <br /> eL- .10019w0an Dark-e!,n" If f a- g zjera r Or pwmnt organhatron 16 a small quaroto generawr reqvired to <br /> PLEASE C PL (MPORMA110N BELOW AND MAIL TO. <br /> San Joaquin County Public Heafth'Servims <br /> Enviratimentof HeRlth DivIslon <br /> 3W E Weber Ave <br /> Stoukton, CA 9620.2 <br /> lel Waste Haulerilo <br /> 0 Now � m3 <br /> (� y1 QQ, 4 7 <br /> Al i uoin dd <br /> Cho: te: po® , �a <br /> Corti et F f'a a r, <br /> Phone <br /> me- <br /> Peffntlkl Tree It Facility�Address: <br /> UK'aR -0-mv se nen fiPtt to � - tf nut ash apa� . at Irs tiz. <br /> `,gyp f aIna: �® <br /> A i % F e e: % all sem VARIS t F k t l watts,. !n' <br /> 00. ,hal - _Cr mekWmi v4o 4; r a Aret at r or heafm two pmftaiuM. r4i,f i tyl <br /> Applicant Signature; <br /> blot Write Below This Lire 41/P,� / <br /> Cr <br /> RIJ�.H.S. Applicalon A4al. _a I W'' -t) g:`0„ 710` "m jinn i <br /> MUM 1"i-96 rutag IVIIA '- — h at k# Wa"aetW Acct-- <br /> N <br />