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8-25-1999 12: 1 1 PM FROM � . P. 4 <br /> CERTMCATION STATEINMN ' <br /> FOR NON-IMEDICAL WASTE GENER TORS A.NL D MEDICAL WASTE GENERATORS <br /> NOT REQUIRED TO REGISTER <br /> (Please Type or Prix) <br /> BUSr.-ESS INANE: A lk-y � rte- Cay _ <br /> BUSINESS ADDRESS: <br /> Street �azc�s - 02 <br /> City tate Zip gS-CZ0 <br /> vAjv, E OF RESPONSIBLE PERSON: �('C� � 721CJ51L�C) <br /> FHONT NFUNMER. (�V -- 01 O <br /> I Am Not Required To Register As A Medical Waste Generator Bemuse: <br /> Tease check the appropriate staternent(s).] <br /> I do not generate any medical waste. <br /> r 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 /> aucrowaving. <br /> Other <br /> of I w te: <br /> Place an "X ' near to the corresponding method your facility uses to dispose of isIt ms <br /> Than �' LCa WLR sr <br /> /Registered �ie Ntedical ast sp <br /> ortername) <br /> ��q - iA- F=$q�C)ottef <br /> Alternative Tecbjaology Approved by DNS (treatment method) <br /> I declare under penalty of law that to the best of my knowledge and belief, I do nor generate or store any <br /> of the wastes specified an the "Pre.-Application Questionnaire" as "Regulated Medical Wastes" in an <br /> amount over 200 pounds per mondt I also declare that I will not be treating any amounr of"Regulated <br /> 1V.ledical Wastes" at M facility by way of auroclaving, incinerating, or microwaving. <br /> SIGNA T <br /> (NOTE: tF YOU OUT"CERTIFICATION" FORM DO NOT FILL OUT"REGISTRATIOW FORM) <br /> 3 <br />