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FROM TRI VALLEY FAX NO. : 209 957 7866 ec. 08 2000 05:59PM P2 <br /> 0 to I N._ V j_ <br /> Sari Jcaqu'n County Pub('-,c Health Services <br /> Envlronmentai health Divislor, <br /> Medical VJaste Management Program <br /> APPLICATION FOR A LIMITED QUANTITY NAUUNG VIP-nON <br /> 7c ;galley for a 'Umitsd Quar,C i4auling ZxcmGdcn" pursuant to the Was;®1M9r2VMe11t AC", the following <br /> candiftns roust he met <br /> me generator cr health core pmiessicnaf gencrates lass than 2C p®unas Or me C:W waste parwooK tr nspers less <br /> loan 20 Q®finds of medical wast at any one time. mina a uncklr g ctooc:ssrrtent pursuant Chapter 6, and Ghc <br /> gereratar or parent crpa*,St cn has ort lie one of the,Icaiowlrsg: <br /> I- Medica!Wass,uansgement plan I the gememtpr orparent orgar>=dan rs a urge c=usrttity genevtor de a small <br /> quan*generator regtdred to register p t to Chaptar 4. <br /> Z- lneormatiort D=meAt If the ;®aerator cr 04mnt crganizztien Is a sn'411 quantity Ganamtor not required t <br /> rs9ts4r purst:ant to Chtapt�r 4. <br /> PLEAsE CCMPL_cM THE INFORMATION BELOW AN WITH 907 FEE To: <br /> San Joaquin County Public Health Servicm <br /> Environmental Health ONision <br /> Medical Waste Management Program <br /> 304 E Weber Ave <br /> Stcckaen, CA 36202 <br /> New M Ftew.va1 Medical sista Hauler lnfct; ation <br /> ,Medal Of C"usinsss N;zme:. TRI-VALLEY HOME HEALTH CAREINC . <br /> M64!=14fffa9/8uslness Addr=; 37 West YokutS Ave. SMItg <br /> City: Stockton SjQ <br /> q�:���p Cade: to 1� <br /> CantactAerse;n: Neczta T. TrIU,2 o-Admi.nistrato Fhoraa -2..0 :.9.52-0708 <br /> Storage Fa©5ty Narte: TR I-V.Ai Will PON <br /> HOME HEAL H C F IN <br /> Storage Facility Address: 37 West Y o k u s Ave. Su i <br /> Stockton <br /> S=W. ,,_2ip Cade: 9L 20'7 <br /> Pt-nn rtL !Lty InigrateEvon 9aZ SXsm � alWa.se Systei <br /> nc. <br /> HhSt9k � j� <br /> Clka <br /> p Ct7d�. <br /> !ret au err}stayss rrsrra arrt�LL's—LUekCftl is bm4pan tho madwal imsM. if nrif N771=71W 1W If:foffAdx- <br /> -- Nom: Necita Tri uero-RN T'de• Amado Guerzo-RN <br /> 7- Name: Madonna Pf Z-RN <br /> Tito:Ari n <br /> dela Cr - V <br /> 3- Narw Alice Dui�,j� vN� '!i{ Antonie a Ma ki-TV <br /> Dawn Sanders-LVN Eliga Wilson-RN Comfort Mat d] -LVN <br /> A cafy*f"vxerntXfan and A traekTag daaurssgtst shalt D4 is S ort A aA ftAd"a#ttanspp 4 we're , in <br /> addl.Cm:!1 tragi®S ad rrtedks!vanam surds stma ho Itapt®rt at sonvatoft er he fth=M.' <br /> Applicant$IQttalturEr '�/`� � <br /> Tula: A- istrat r ®tom: I2„�lQ'7w_ ,IZQQ <br /> Oa Nat Write Below This t ing . <br /> R.:.r.5.Applie3tica h�provsi: ! <br /> Oate:.�.�1.�(?�EzPit�►ttats t7ate• Z r.(�D <br /> ;:i43G2 ra t=a_es bats ?aid 51 /d h ar �cfc_� iGitde3s <br />