Laserfiche WebLink
Certification <br /> FOR NON-MIEDICAL WAS'T'E GENERATORS AND MEDICAL WASTE GENERATORS NOT REQUIRED TO REGISTER <br /> Business Name: 5 A 1 r,,U_0_j 'D\PAJ Sk S — TV P- CL <br /> Business Address: 215 6 ME S T Ci nT I-V% (i,7. S I Ili 1 <br /> City State Zip Code <br /> Phone Number: (�1 �1 ) A <br /> Contact Person: y t � <br /> I am not required to register as a Medical Waste Generator because: <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, incinerating or <br /> microwaving. <br /> ❑ Other: <br /> Please indicate the appropriate statement(s): <br /> I declare under penalty of law that to the best of my knowledge and belief,I do not generate or <br /> store any of the wastes specified on the "Pre-Application Questionnaire" as regulated medical <br /> wastes in an amount that equals or exceeds 200 pounds per month. <br /> I declare under penalty of law that I will not be treating any amount of regulated medical wastes <br /> at my facility by way of autoclaving, incinerating or microwaving. <br /> Signqure: Title:$WIVT TVk\I'kC4P fl Date: Qt (Q V/e0z_ <br /> EHD 45-03 3 <br />