Laserfiche WebLink
0 <br /> REGISTRATION FOR MEDICAL WASTE <br /> FOR GENERATORS OF MEDICAL WASTE <br /> GENERATOR NAME. r-.OffbkD iko 11hrowe, &Rii Joaqw--Lb <br /> L/ <br /> GENERATOR FACILITY ADDRESS <br /> Street.3 i i,�� wrs� Mapz�h Lo kr Ew+ A <br /> City Sibckl-0yi State 04 zip 060liq <br /> Phone Number Caoq) <br /> GENERATOR MAILING ADDRESS <br /> Street S <br /> — <br /> City state Zip <br /> TYPE OF BUSINESS <br /> AUTHORIZED REPRESENTATIVE h1lq 6�Vh 0 k7-1 RAJ <br /> TITLE <br /> EMERGENCY PHONE NUMBER <br /> REGISTRATION FOR: <br /> Small Quantity Generator with onsite, treatment (Generates less than 200 lbs/month) <br /> Large Quantity Generator Only (Generates more than 200 lbs/month) <br /> Large Quantity Generator with onsite treatment (Generates 200 lbs or more/month) <br /> I declare under penalty of law that to the best of my knowledge and belief the statements made <br /> herein are.correct and true. I hereby consent to all necessary inspections made pursuant to the <br /> California Medical Waste Management Act and incidental to the issuance of this registration and <br /> the operation of this business. <br /> SIGNATUREJ�� awtqA�—TITLE. 1 DATE <br /> 4 <br />