Laserfiche WebLink
Sanquin Cot-inty -*ublic Health Service <br /> environmental Health Division <br /> Medical Waste Management Program <br /> APPL1CATON FOR A LIMITED QUANTITY HAULING EXEMPTION. . <br /> To qualify for a "Limited Quantity Hauling Exemption" pursuant to the "Medical Waste Management Pict", the following <br /> conditions must be met <br /> T he generator or health care professional generates less than 20 pounds of medical waste per week, transports less <br /> than 20 pounds of medical waste at any one time. maintains a tracking document pursuant to Chapter 6, and the <br /> generator or parent organization has on file one of the following: <br /> 1- Medical Waste Management Pfan if the generator or parent organization is a large quantity generator or a small <br /> quantity generator required to register pursuant to Chapter 4. <br /> 2- Information Document if the generator or parent organization is a small quantity generator not required to <br /> register pursuant to Chapter 4. <br /> PLEASE COMPLETE THE INFORMATION BELOW AND MAIL WITH 560: <br /> San Joaquin County Public Health Services <br /> Environmental Health Division <br /> Medical Waste Management Program <br /> 304 E Weber Ave <br /> Stockton, CA 95202 ;' J <br /> ,- <br /> Medical Waste Hauler Information <br /> C3 New 2 Renewal <br /> Medical Office/Business Name: Manteca Unified School District ouise Avenue - <br /> Medical Office/Business Address: Post ice ox - as A <br /> City: Manteca State: Zip Code: <br /> x782 <br /> Contact Person: Betty Ingeli, R.N. , Phone 209-825-3200 <br /> Storage Facility Name: Manteca Unified School District <br /> Storage Facility Address. 290 East Louise Avenue <br /> City: <br /> Lathrop State: CA Zip Cade: 95330 <br /> *Permitted Treatment Facility Name: Integrated Environmental Systems — <br /> Permitted Treatment Facility Address:-499 High Street <br /> Oakland State: CA Zp C--ds: 94601 <br /> List all employee names and titles authorized to transport the medical waste. If not enough space, attach information. <br /> 1- Name: See attachment Title: <br /> 2- Name: Title: <br /> 3- Name: Title: <br /> A copy of this exemption and a tracking document shall be in employee's possession at all times while tim porting medical`haste• in <br /> addition, all copies of medical was records shall be kept on file at generators or health care professionaPs facility <br /> Applicant Signature: ' <br /> Title' Director c Health Special �Eda`tion Date: <br /> 11 / 29 / 99 <br /> Do Not Write Below This Line <br /> R.E.H.S. Application Approval. �- Dater Expiration Date-J,-- <br /> EH4502 1403-96 Date Paid /.2/ /7 / 9 ZCash CC&eck T y 77gS7 (circle) Acct <br />