COMPLIANCE INFO_2011-2017 - Laserfiche WebLink

Home Browse Search

MAY/13/2011/FRI 13:48 • • P.005 Registration Medical Waste For Generators of Medical Waste GENERATOR NAME: 50- 6 `L �l l it Generator FacilityAddzess:Z1 JCP v Gyct./1 t-t�'� "GISTRATION FOR: ❑ Small Quantity Generator with Onsite Treatment (Generates less than 2001bs/month). Large Quantity Generator Only (Generates 200 lbs or more/month). ❑ Large Quantity Generator with Onsite Treatment (Generates 200 lbs or more/month). I declare under penalty of law that to the best of my knowledge and belief the statements made herein are correct and true. I hereby consent to all necessary inspections made pursuant to the California Medical Waste Management Act and incidental to the issuance of this registration and the operation of this business. Signature: MiD 45-03 4 10/6/2003 TnxLu OA cts 3T+ Phone dumber: City Z q - State Zip Code r 2.0 --R Z co-'/ Generator Mailing Address: �a�f`lt IJ n ccSCS 1. ~ Z6� �'`j•C7�q� f`j.'A4 (�0. 5vr� l� Tamar c.0 r q5 -33:7 - city T state zip code Type of Business: D l a %S t S d qdl i C-, Authorized Representative: Al Cwis 0(01 Title: L iL -Ee,J/1 n i CA S 01&ert t S Inr Emergency Phone Number: (2.0 RL -(2-9 (Ut( f7IAki1e- 1 "GISTRATION FOR: ❑ Small Quantity Generator with Onsite Treatment (Generates less than 2001bs/month). Large Quantity Generator Only (Generates 200 lbs or more/month). ❑ Large Quantity Generator with Onsite Treatment (Generates 200 lbs or more/month). I declare under penalty of law that to the best of my knowledge and belief the statements made herein are correct and true. I hereby consent to all necessary inspections made pursuant to the California Medical Waste Management Act and incidental to the issuance of this registration and the operation of this business. Signature: MiD 45-03 4 10/6/2003