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REGIS"ITtATION FOR MEDICAL WASTE <br /> (Please Type or t) <br /> GENERATOR E: DAMERON .xoSPITAL ASSOCIATION <br /> GENERATOR FACI S: <br /> Street 525 West Acacia Street <br /> City Stockton State CA Zip 95203 <br /> Phone Number (20q ) 944-5550 <br /> GENERATOR MAILING SS: <br /> Street 525 West Acacia Street <br /> City Stockton State CA Zip 952Q3 <br /> TYPE OF BUSINESS: HOSPITAL <br /> AUTHORIZEDREPRESENTATIVE. Mark G. Koenig <br /> TIT Chairman, Safety Committee's <br /> EMERGENCY PHONE NUMBER: ( 209 ) 944-5550 pager 212 <br /> REGISTRATION FOR: <br /> (Check One) <br /> ( ) Small Quantity Generator With Onsite Treatment. (Generates < 200 lbs./mo.) <br /> OLarge Quantity Generator Only. (Generates 200 or more lbs./ o.) <br /> Large Quantity Generator With Onsite Treatment. (Generates 200 or more lbs./ o.) <br /> I declare under penalty of law that to the best of my knowledge and belief the statements <br /> made herein are correct and true. I hereby consent to aH necessary inspections made <br /> pursuant to the California Medical Waste Management Act and incidental to the issuance <br /> of this registration and the operation of this business. <br /> Chairman, <br /> SIGH Safety Cmte.DATE. 10/7/91 <br /> 6 <br />