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Aug-22-02 08:34A P.02 <br /> .. ..-•Jot LOU4 Lo. Ida 4C1n'40 )J rAr in rLtvn /� ; <br /> {' San Joaquin County Pubfic Health Servic--s // <br /> Environmental Health Division <br /> Medical Waste Management Program <br /> APPILICATION FOR A LIMITED QUANTITY HAll1-1NG EXEMPTION <br /> To quaff .bra"Limited Quantity t�augng exernoon" pursuarrt to ttrs'M- 8diCal Was'„2 MartagQrrtant Ac", the`dll�wirtg <br /> rid it must he rt&L <br /> The generator or hea* care profEssiortal generates less than 20 Peunds of MI Wave per v,reek tanspods less. <br /> '�tfatr 2� pounds of rn dicot waste =i arty ane dme. matnfains a tracking document pursuant b C,'saptu S, and the <br /> generator or parent organfatian has an die one of TheSoilawing: <br /> for er atom arganizatfan is a II quantity Senera�or.a sinal <br /> 1_ Medica!Wast Manaq+emarat Flan if Lite 9eC�'a t to Ct►apter 4. <br /> quantity generator required to r¢e3ister pursua <br /> Z- lnfprmatrarr G�ocument it the generator or Went orgartbmton is a small quwtity generator nat nsq to <br /> register pursuknt to chapter a. <br /> , t rE�vW;SND MAIL 'S47 VE5 <br /> P1EASE C.0MAnLL d ♦VCz I1eauA.- r. <br /> ]L <br /> San Joaquin Cour ty Public Health Services <br /> Environmental H Ith Division AUG 1 5 2002 <br /> Medical Waste MOnagement Program ENVIRONMENT HEALTH <br /> 304 E Weber Ave, PERMIT/SERVICES <br /> Stockton, CA 95102 <br /> Medical Waste Hauler Information <br /> Naw r Renewal <br /> Medical afte/susin� Name: �� S <br /> Medical 01 s Address: l State:- �/� 1p Cade: <br /> City: Phone <br /> Contact Person: <br /> Storage Par6iity Na <br /> Storage Facs+jty Add <br /> State. zffP Cada <br /> Permitted Traatmenti Fang°`' ?�ar,te� e � Y. <br /> Permitted Tre2lmsad Fadit11 Address` Ztp Calms= <br /> ------------------ <br /> Qrt dta medical waste. if not enough space. attadt inforittatio". <br /> +est ail ernployee M#nes and ts'ltes aUthor�d to hansp 7 <br /> �- . / l"� <br /> 2- Nana: 1 nv Tine: 3 +✓.°_ . <br /> 1d. Oct �✓ '�� a aiin aR ill ate.+Wil.sarxPerrkte ffaha .�rasm trt <br /> A mpy of this and a documo t shau be in emplo+lea's <br /> idCwen ad copies of <br /> +rest en Ste at 4ener2Wr'x at heaft caws�s <br /> A091icartt Sigrtatute: paw '� I l �. z <br /> Tide: � <br /> De Nor Wire aelow This Line <br /> WL— <br /> Q-E,H-S. ApplicatianiAppra'al: , J t'ath ���{cTrdel tiaQ <br /> >:l14302 ZGC3 Bale Paid <br /> s- <br />