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CERTEFI,ifiTION <br />•. • r ' •- ' I •,. <br />AffiA— <br />NOT REQUIRED T•REGISTER <br />(Please <br />BUSINESS NAME: <br />Street <br />City State Zip <br />I Am Not Required To Register As A Medical Waste Generator use: <br />[Please check the appropriate statement(s).] , <br />I do not generate any medical waste. <br />I generate less than 200 pounds of medical waste per month. <br />I do not treat any medical waste at my facility by means of autoclaving, <br />incinerating or microwaving. <br />IM <br />() I declare under penalty of law that to the best of my knowledge and belief, I do not <br />generate or store any of the wastes specified on the "Pre -Application Questionnaire" <br />as "Regulated Medical Wastes" in an amount over 200 pounds per month. <br />() I declare under penalty of law that I will not be treating any amount of "Regulated <br />Medical Wastes" at my facility by way of autoclaving, incinerating, or microwaving. <br />SIGNATURE: TITLE: DATE: <br />F <br />