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Registration Medical Waste <br />For Generators of Medical Waste <br />GENERATOR NAME: <br />S�• 0 is ' I'Yt GtT� C,61,�Z <br />C�111�1 <br />Generator Facility Address: <br />STU <br />Cid <br />952-10 <br />Phone Number: <br />City <br />(boat) <br />State <br />Zip Code <br />Generator Mailing Address: <br />NN) I r {nta CiTef'ifi <br />s -D <br />c k <br />95--c;�-a 4 <br />City <br />State <br />Zip Code <br />Type of Business: <br />fteAl+w& <br />Authorized Representative: <br />r yl -ry <br />Title: <br />st4ive& <br />Emergency Phone Number: <br />❑ Small Quantity Generator with Onsite Treatment (Generates less than 200 lbs/month). <br />Large Quantity Generator Only (Generates 200 lbs or more/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 herein <br />are correct and true. I hereby consent to all necessary inspections made pursuant to the California <br />Medical Waste Management Act and incidental to the issuance of this registration and the operation <br />of this business. <br />[If <br />EHD 45-03 4 <br />10/6/2003 <br />