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CERTIFICATION STATEMENT <br /> R NON-MEDICAL GENERATORS AND MEDICALGENERATORS <br /> NOT REQUIRED TO I <br /> (Please Type or Print) <br /> BUSINESS : <br /> BUSINESS AD SS: <br /> Street <br /> City State Zip <br /> PHONE NUMBER: <br /> NAME OF RESPONSIBLE PE : <br /> I Am Not Rmluired To Register As A edical Generator : <br /> [Please check the appropriate statemen s)°] <br /> I do not generate any medical waste. <br /> I generate less than 200 pounds medi waste per month. <br /> I do not treat any medical w e at my fa ° ' by means of autoclaving, <br /> incinerating or microwa ° <br /> Other <br /> P/ae ' to Statement(s): <br /> penal of law at to a best of my olede b , I do not <br /> e y of the wastes spec° ed on the ' -A tion do " <br /> " ° o t over 200 o ds permpen ty of law at I not be treating y o t of" ate at my facility by of autoclaving, incinerating, or micro a ° g. <br /> SIGNDATE: <br /> 5 <br />