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<br />SAN 3OAQUi (20VNT, <br />`° r}I IT�ONh�l V7'A L AZ.TH DJ9PAA'i_ .BM <br />R 600 F-utnl n Sftot$, StockWx> CA 95202-3029 <br />Td'epho a. (204) 4684420 .Fo" M)9) 44.3433 Wrh; w".ggw-orgretld <br />UCA'ION FOR A LBMTiD Q1crANrM,"3WGLVMVMWX0Xj <br />` O gtxali''O foa- a `7,Wr,ad Qup,wity y;•Tauling Enmption" pumFxaut to th0 , rJCUcal Wast--ag o,n Ace'. Liza cFllvwang <br />cour W0119 rMst be met: <br />The.Rctemtor or I=. Ith c= pznfb M0W loSiva tbg lc ,s tan 20 paana5 of tnaa3eat ova perlwocic. tFa�sport less <br />tlFa.,t} at)I pwrid9 0 1zt c2] pur m�, tn�{ni;8ins a arkiug documcnt puxsimnt to Chaptcr 6 acid the <br />gCaciator or parent orp.nizarilxl 1MV Dp fUc Mq. of t o foilomngc <br />1. Medjoat a Pd dliag6tflartP,nlr tMa generator or PA= orgaa)V40n is a large rz ' <br />or a. small quasily gen>; for mqu and to rcgi!ter pursuant to Cha.,pmr 4, � �►� !�e>ac1 r <br />2. InfoYMIdon 1 omMent afitbc gazetatof or pamttt organiz,iort za a, ama!! qua:tifty g®ttcratnr not requited <br />to roprj W pumint to Chapter 4. <br />JPkhsc co>cziptetes ft infarmat£Dn blow and M-34 With 5;77.00 flee to; <br />SUFI 7oagt1ltl County Envimomenta! RMU pcpaztme"t <br />Medical 'Wrote Fbnagmmt .Ptogr= <br />G00 Jt�.��ain, S`trcet, 5toclttGai, CA, 95202-30,29 <br />4l. <br />®.New X Rtn tl <br />edIcq.1 OfficefIR"A ess NamaA S as )'ub ' Z�altkl civieres <br />Modica) mice -Busit3evs Addrutzi 1601 : ke1ka a <br />95205 <br />Comma Person: city stool zip <br />i1'ikk' it �rlit <br />khoac NiF.mber: <br />9tairilge Facilib. Tya en Sag7p 't1 Count~ ° ��� ' <br />S rtx a a,cilx!•y .Addy gs:on A��--- _ <br />Cty <br />cltton !Code <br />__ <br />T:"et'witTet)';frlra.�xltazlt[cScle <br />Feinted r[Tmatment, racIllty Addren: -_ _ _ _ 4135 w. Swift Ave. <br />city 'rte -,P0 • , 5tata <br />Tip Code <br />Lig all CmpIOyCEr ii1t11C5 and txt1as atztb4r>a ed to txagsprnrCtilo modicaT'wa. to (Wnlora than 3, dfch i th): <br />T. Name: Seo aracbed iuF�o TAtI¢: <br />3, Narnc' --- Title: <br />A copy of this examption and a tracking document shag be in empkoy"'s posmosxion at all tirnes whoa t,•aroportin® m(t4lool wa6tQ. in <br />addition, *9 coprft c4 MOdlCai waste rae®rds shse11,40, Kept on tike at gene,atar's or tmnith care prafeasionars-facill-W. <br />Applicant <br />�T,/L) <br />Do Not Write Below This Line <br />R.E,H.S. Application Approval: Dat®; 0 l Expiration Date:-- 1 j <br />U14$02 1a -o3-96 bate Paid I'-/ It t t Cash or Check ;. (circle) Acct--_____ <br />Received Time Jan,23. 2013 1:27PM No,0435 <br />