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Registration for Medical Waste <br /> For Generators of Medical Waste <br /> GENERATOR NAME: SUTTER TRACY COMMUNITY HOSPITAL <br /> Generator Facility Address: 1420 North Tracy Boulevard <br /> Tracy- CA 95376 <br /> City State Zip Code <br /> Phone Number: 209. 835. 1500 <br /> Generator Mailing Address: 1420 North'fraev Boulevard <br /> Tracy CA 95376 <br /> City State Zip Code <br /> Type of Business: Acute Care Hospital <br /> Authorized Representative: Dawn Kent <br /> Title; EVS Manager <br /> Emergency Phone Number: 209-832-6053 <br /> REGISTRATION FOR: <br /> Small Quantity Generator with Onsite Treatment(Generates less than 200 lbs/month). <br /> ❑ Large Quantity Generator Only(Generates 200 lbs or more/month). <br /> Large Quantity Generator with Onsite Treatment(Generates 200 lbs or more/month). <br /> I declare under penalty of haw that to the best of my knowledge and belief the statements made herein <br /> are correct and true. I hereby consent to all necessaij,inspections made pursuant to the California <br /> Medical Waste Management Act and incidental to the issuance of this registration and the operation <br /> of this business. <br /> Signature: Title: EVS Manager Date: <br /> EHD 43-0.3 4 <br /> 2015 <br />