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;o�'titi -"ub(ic Health Servic <br /> PUS 1C EALTH SERBS mental Health Division <br /> <<� sAl JOAQUIN COUNTY ste Management Program <br /> xas Y L. OLEY,R.E.H.S. ITED QUANTITY HAULING EXEMPTION <br /> Lead Senior Re,istere Environmental Health Specialist <br /> Environmental I ant to the "Medical Waste Management Act", the following <br /> (209) 468-3451 �- ,-�'4 <br /> FAX (209) 468-- <br /> Email:KFole}Ca <br /> GO(p l a4;pl kbCfl i,an 20 pounds of medical waste per week, transports less <br /> than 20 po :- ins a tracking document pursuant to Chapter 6, and the <br /> generator o f'z°fO�� - C It"1.� �ing: <br /> bIJ J� -f� t�4S-te. a <br /> 1- Mec C>�'i (parent organization is a large quantity generator or a small <br /> qua ( 1(-eYYtbV'� haptet 4. <br /> 2- Into "I OJ d V rer-I' 4ue-G--pt-+'1`n if 'f't7 <br /> I anization is a small quantity generator not required to <br /> j9 q tY g <br /> regi` Ce&t- 0jIS-be 5o (ctfn'-Lx-e- gCr0 1 <br /> PLEASE CC Q It IL WITH S67 FEE TO: <br /> San Joaqt <br /> EnvironmE <br /> Medical Waste Management Program <br /> 304 E Weber Ave <br /> Stockton, CA 95202 � <br /> '. I <br /> j <br /> Medical Waste Hauler Information <br /> 0 New ® Renewal <br /> Medical Office/Business Name: Manteca Unified School District <br /> Medical Office/Business Address: Post office Box 32 - 29ul Easto - <br /> Latnrap, CA <br /> City: Manteca State: UA Zip Code: <br /> 95336 <br /> Contact Person: Betty Ingell, R.N. , Phone t 209-825-3200 x782 <br /> Storage Facility Name: <br /> Storage Facility Address: <br /> City: State: Zip Code: <br /> Permitted Treatment Facility Name: Manteca Unified School District <br /> Permitted Treatment Facility Address: 2901 East Louise avenue CA <br /> City: Lathrop I State; Zip Code: 95330 <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 docwnent shall be in employee's possession at all times while transporting medical waste. In <br /> addition, all copies of medical was a records shad be kept on file at generator's or health care professional's fau7lty- <br /> Applicant Signature: <br /> Title• Director of Health VSpecial Edddation Date: 11 / 29 99 <br /> Do Not Write Below This Line <br /> R.E.H.S. Application Approval: Date: / / Expiration Date: <br /> EH4502 10-03-96 Date Paid /2./ /7 / 99 Cash Check q77gS7 (circle) Acet_„(jb_,_,_,! <br />